Insurer with extensive small group line of business

Problem: Group Insurer needed to assess how well current procedures were identifying and pursuing claim recoveries for small employer accounts. Internal programming and technical support was devoted to other priority efforts so external assistance was needed.

Action: Health Decisions reviewed all internal and external recovery efforts to identify overlaps and gaps. Health Decisions then performed an electronic audit to identify additional areas of recovery.

Result: Current efforts were continued but duplication and overlap were eliminated by the use of Health Decision’s Paperless Case Review software suite. Additional recovery areas also were added. Total staff time devoted to recovery decreased and recovery collections increased.