OPL has the capabilities to support, enhance or replace many of the functions of your Other Party Liability Department through the implementation and administration of a comprehensive and aggressive program of coordination of benefits and subrogation identification and administration. We can increase group customer satisfaction and executive management financial concerns through greater recoveries, coupled with improved tracking and reporting methods for both senior management and group customers.

OPL has the capacity to accept claim tapes or electronic transfers to generate its own questionnaire to your subscribers. OPL can also aggregate claims paid data, by subscriber, to eliminate the need for claim updates. OPL's proprietary Windows-based tracking system can identify and report upon all of your cases instantly.

INDEPENDENT INVESTIGATION OF COURT RECORDS
To further assist with subrogation claim identification, OPL is currently initiating court house searches for subrogation claims in each of our clients' major markets. These additional claim identification services are done free of charge and are considered included as part of the contingent fees collected on cases in which we do recover. We are prepared to retain persons to review courthouse records in your plan area which can then be compared with your subscriber data files. It is impressive to Group customers to let them know that even if a subscriber does not respond to the plan's inquiries, if there is a lawsuit filed, the plan will be able to identify and recover its interest. This has the further benefit of thwarting plaintiffs attorneys who, in some parts of the country, routinely advise their clients not to respond to subrogation inquiries (particularly if your plan is pay and pursue).

OPL has committed itself to serving the coordination of benefit and subrogation needs of insurers, health plans, TPAs, stop loss carriers, and individual groups. We recognize that subrogation is but a small portion of the health benefit administration and customer service responsibility. Our staff is trained to clearly explain subrogation principles to your members and not to upset subscribers through heavy-handed collection tactics. Our focus is on both your satisfaction of our firm as a vendor and your customer's approval of our firm's interaction with subscribers on behalf of the plan. Plans should be careful not to hire subrogation vendors whose short-term financial goals (promises of 1% of claims) may jeopardize your control over the subrogation process and the plan's long-term relationships with its customers. Our focus is not exclusively the recovery of subrogation funds in any particular case, but rather insuring that the Plan systematically pursues and identifies all possible subrogation claims in a documented, effective revenue-producing manner. This will maximize the dollar value of your subrogation recoveries and the Plan's relationship with its customers. It is important for you to have detailed supporting documentation about overall and specific subrogation activities in order to demonstrate to management that your area is cost efficient and to show experienced rated customers that the Plan really cares about the health care dollars that it is administering on their behalf. The reporting information from this program will further show management and customers that you are diligently performing the administrative functions outlined in the benefit agreements. Once a comprehensive program is in place, the amount of subrogation funds recovered will dramatically increase.

All closed cases are reported with the reason why each case was closed. You will then be able to run reports not only to show how many cases you have investigated and closed, but why, in each particular case, a recovery could not be secured. This type of information is very impressive to auditors and consultants.

The outsource attorneys supplement the plan's current investigative and administrative efforts through the identification of claims and identification of possible subrogation cases to the plan. The outsource attorneys then contact subscribers or their attorneys to determine whether the plan has a right of subrogation recovery.

Once a claim has been identified and confirmed by the outsource attorney as potentially viable, only then will the outsource attorney request claims paid histories. If necessary, the outsource attorney may also request contractual and booklet language from the OPL staff (if access to IPDR records is granted, our firm is willing to identify its own claim histories as to related and non-related claims). Please note that our experience has shown that there is only a minimal ability to reduce OPL staff with the advent of outsourcing since the number of claims being pursued will increase dramatically.

To find out more about our process, e-mail us today or call (412) 429-1769.

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