HARTFORD, Conn.--()--SCIO Health Analytics today announced the launch of the latest edition of Subro Accelerator, a leading-edge predictive modeling technology and service that provides a new opportunity for payers, especially in anti-subrogation States, to identify potential Third Party Liability claims before they are paid.
“In the challenging and ever-changing field of subrogation, continued innovation in health plan specific opportunities for additional claim-cost management is more important than ever”
Designed to complement existing post-payment subrogation activities, Subro Accelerator serves as a novel, analytics-driven, pre-payment identification solution that allows a percentage of claims to be identified as potential for TPL after adjudication, but before claims are actually paid.
“This latest version of Subro Accelerator is able to provide a ‘pay or pend’ decision on over 50% of claims within six hours of receiving the claim, with additional 10-30% being confirmed within 48 business hours,” said Brendon Tucker, SCIO’s Senior Vice President, OPL Services. “Time is of the essence, since health plans can realize an immediate increase in financial return of as much as 30-45% per case, by avoiding fees and reductions associated with traditional post-payment processes.”
Subro Accelerator has predictive algorithms that take into account a range of quantitative and subjective factors such as state-specific subrogation laws and the propensity of motor vehicle accident and workers’ compensation claims.
“In the challenging and ever-changing field of subrogation, continued innovation in health plan specific opportunities for additional claim-cost management is more important than ever,” said Karthik Krishnaswami, President, TPL and Analytics Services at SCIO Health Analytics. “Implementation of an analytics-driven solution such as Subro Accelerator, allows health plans and sponsors to minimize avoidable disbursements, curtail the costs of post-payment recovery, and better manage the cost of claims.”
Subro Accelerator receives pre-paid claims feeds from payers on a daily basis, and potential Third-Party Liability claims are identified with proprietary and targeted codes, predictive modeling and clinical groupers. These analytics-driven functions isolate about 2% of all claims and release the remaining files to the payer within 12-48 hours, depending on the health plan’s volume, receiving system and complexity of claims processes.
The claims identified as having a high probability score for subrogation are pended for five to seven business days, depending on plan-specific requirements. Relying on inherent technology, analytics, processes and global resources, Subro Accelerator executes a multi-tiered investigation process, combining manual claims review, outbound phone calls and/or e-mails, the mining of specific external databases, and the initiation of written communications when time and circumstances permit.
By implementing Subro Accelerator, participating health plans are able to realize greater savings when claims are stopped prior to payment. This savings is captured and realized between 9 to 24 months in advance of when payment would have recouped through traditional post-payment methodologies. In cases where Subro Accelerator is unable to confirm or deny the potential of OPL, the technology can pass the file to the internal department or external vendor that provides the more traditional post-payment identification, investigation, and subrogation processing well before it would have been identified under the traditional pay-and-pursue model.
For more information, visit: www.sciohealthanalytics.com/Subro_Accelerator
About SCIO Health Analytics
Based in West Hartford, Connecticut, SCIO Health Analytics is a leading health analytics company, serving more than 50 health care organizations including 15 of the top 25 insurers that represent more than 80 million members. SCIO Health Analytics provides actionable and predictive analytics, business services and insights in the areas of payment integrity, care and risk management, value-based benefit design, consumer engagement, ACO analytics, and network analytics to improve healthcare services and results.