Subrogation: 3 ways SaaS can help

For many health plans, the challenges associated with subrogation―the process of recovering healthcare claim payments that are a third-party’s responsibility―are significant. Outdated identification methods, potential member abrasion, slow validation processes, and marginal settlement rates all impact your ability to appropriately contain and recover costs.

How can you overcome these challenges and maximize recoveries in less time and at a lower cost? Software-as-a-Service (SaaS) applications are a way to enhance your subrogation programs and recoveries. Plans are finding that the combined power of transformative technology and in-house expertise facilitates a more effective, data-driven approach for finding and validating recovery opportunities with minimal member abrasion.

With this in mind, here are three simple but powerful ways SaaS solutions can help you optimize your subrogation operations:

#1: Make in-house recovery management more efficient and insightful

The power of automation allows health plans to do more with less. Built-in algorithms, advanced data-mining techniques, and machine learning work to effortlessly manage cases and shorten the information gathering process. Reporting and analysis give instant and sharable views into recovery efforts. Combine these solutions with user-defined customization options that can be tailored to your needs, and the once burdensome task of subrogation becomes a breeze.

#2: Gain accessible, easy-to-use, highly scalable, and secure solutions

With SaaS, there’s no need for rigorous installs or startups. The system can scale drastically and on-demand, depending on your organization’s needs. Most importantly, the security and fail-safe measures in place not only guarantee continued operations in an emergency, but also consistently ensure that HIPAA and HITRUST CSF® certification requirements are met.

#3: Do more at a lower cost

With the advent of cloud technology, SaaS offers a significant boost to the bottom line for any business. Every application can be accessed from a simple desktop, and processes have been streamlined to make it as painless as possible. Regular, non-disruptive system enhancements work to improve your solutions as well, so your recovery efforts—and your business—continually evolve without interruption.

In a highly competitive marketplace where claims accuracy and cost containment are paramount, SaaS applications can empower your plan with improved efficiencies and productivity―facilitating more accurate payment decisions and generating greater recoveries.

To learn more about the benefits of SaaS applications for subrogation, download our white paper or visit our Subrogation solutions page.

Heather RodemannSubrogation: 3 ways SaaS can help
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Discovery Health Partners transforms healthcare recovery with SaaS

ROLLING MEADOWS, IL (June 6, 2012) – Discovery Health Partners, a provider of intelligent healthcare cost containment solutions, today announced that a new health plan customer has successfully implemented its software-as-a-service (SaaS)-based Subrogation service.  The SaaS delivery model is an alternative to the traditional Full Service outsourcing that Discovery Health Partners has delivered to health plan and self-funded customers since 2008.

For a western region Blues health plan, Discovery Health Partners built a Virtual Private Cloud (VPC) to support and enhance the collections, insight, reporting and productivity of existing internal pre-payment and recovery Subrogation processes. In the VPC, claims data resides in Discovery Health Partners’ privately hosted, secure environment for Subrogation case identification, case management, and information analytics.

The new SaaS-based healthcare recovery model allows in-house recovery teams to benefit from state-of-the-art technology in a cost-efficient subscription model while retaining full control of the Subrogation function. It operates on Discovery Health Partners’ proprietary Healthcare Analytics Platform, which transforms key healthcare cost management business processes with enterprise-level, cloud-powered information analytics.

For a second customer, a community health plan in the northeast, Discovery Health Partners created a Hybrid Cloud environment, in which sensitive data remains in the customer data center and streams into Discovery Health Partners’ analytic applications only when needed, then returns to the customer data center. This approach represents an incremental step toward the cloud, allowing organizations to reap cloud value while retaining their data on premise.

“These examples of cloud adoption symbolize the seismic shift underway within healthcare, an industry that has long struggled with antiquated technology, overly complex processes, and a lack of information transparency,” said Paul Vosters, President and Chief Operating Officer of Discovery Health Partners. “The cloud is an enabler for competitive advantage. Our HIPAA-compliant SaaS models enable greater flexibility, cost effectiveness and control for the healthcare claims recovery and overpayment industry.”

Three robust, on-demand applications help customers tightly manage their recovery programs:

  • Discovery Identification℠, a sophisticated data mining engine that accurately generates cases for investigation;
  • Discovery Case Manager℠, which delivers modernized workflow, rich case detail, digital imaging and storage, and plan language features; and
  • Discovery Dashboard℠, which provides unprecedented visibility through customized analytics for trend and case reporting

Discovery Health Partners uses commercial cloud services from leading providers such as Amazon Web Services, Informatica, and Microsoft. It includes comprehensive application, data, and infrastructure security controls designed to facilitate security governance and manage ePHI data security. It is fully HIPAA-compliant, meeting rigorous standards for technical, physical, and administrative security.













Discovery Health PartnersDiscovery Health Partners transforms healthcare recovery with SaaS
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