Services for Employers

Services for Employers

OPL provides many services to employer benefit plans in conjunction with claim recoveries.Our experience in the industry has showed us that no matter how large or small the employer group, a comprehensive program of revenue enhancement and plan benefit enforcement must be implemented to effectively maximize returns.We therefore prefer to discuss your current operations and procedures, and advise which of our claim administration tools can best improve your recovery efforts.

We have also found that some employers would like little or no involvement in the process at all, preferring to completely outsource subrogation. Here at OPL we also understand this position and are fully dedicated to benefits a complete process for your COB/Subrogation/ Claim exclusion administration.

TPA Administration

We offer a full suite of claim administration and review. We assist government agencies and third party administrators in making sure subrogation recovery has been maximized and documented. Please give us a call or fill out the contact us portion of the site. We will promptly get back to you and provide you a free assessment of your current opportunities and processes.

Workers Compensation

Employer Plan Language consulting

In addition to providing subrogation services to our clients, we are also available to assist with crafting and revising plan subrogation and COB language. In order to recover the maximum amount of plan benefits and to make the third party recovery program as effective as possible, health care plans should have clear, well designed plan language.

The ability to recover from possible third party tortfeasors is dependent upon the plan’s ability to recover in either equity or contractually. The importance of well-designed plan language is critical, as many state and some federal jurisdictions employ various equitable principles in order to defeat health plan subrogation claims even when there is clear contractual language.

The importance of plan language is further magnified by various laws which may prevent claim recovery such as the make whole rule, the collateral source rule, comparative negligence laws and other state anti-subrogation laws.A complete subrogation reimbursement provision must address a number of scenarios.These include the responsibility of the plan to make payment, the ability of the plan to secure repayment of its claims form the responsible party and the obligation of covered persons under the plan to reimburse or protect the interests of the plan. We can assist you in drafting plan language to address these issues, as well as others, in order to maximize your recovery.

Recovery Forecasting

Depending on your particular type of claim business and recovery opportunities, we are happy to provide you a forecast model showing your current recovery path to your potential recovery path using our services.

Recovery Plan Audits

We provide certified audits of your current recoveries. This includes recovery procedures, data security, realized recovery and analysis of faulty recoveries or malpractice

Dependent Eligibility Audits

By reducing the number of dependents in your plan you will instantly reduce your costs. Not only for future Healthcare claims but for Dental, Vision and other benefits, some employers have even been able to obtain refunds when it is determined that Participants were enrolled when they were not supposed to be. Accurate and timely Eligibility determinations are critical to management of your costs. For example we are aware of employers paying for years for deceased retirees or Medicare eligible spouses

ERISA and HIPPA Compliance Consulting

Third Party Administration and subrogation outsourcing causes many data transmissions to incidentally incur data privacy violations. We can observe your current operations and install firm safeguard technology into your logistics to insure the protection of claim data making firms less susceptible to data theft and federal privacy violations.

Internal Plan Processing and HR Claim Accountability Consulting

Refining the claim processing procedure is a task that should never be overlooked. Internal claim processing must be accurate and efficient to effectively process your paid claims and be able to accurately track your third party recoveries. We provide onsite analysis and procedural auditing to make sure your staff can accurately complete the processing procedure.

TPA Compliance and Subrogation Tracking Oversight

Keeping accurate up to date records and tracking of subrogation is vital to your companies continued recoveries and savings. Your TPA or Subrogation vendor should be providing accurate secure reports of all claims currently under pursuit and recovered on. We provide recovery auditing and surveillance to make sure your plan is recovering funds timely and up to industry standard.

Request a Free Analysis of My Plans Current Recovery (Form)

Well-Crafted Subrogation, Reimbursement & COB

Effective, non-vague recovery language is very crucial. OPL experts have over 20 years of experience, drafting state specific subrogation language geared toward optimal recovery for your plan. Our experts will provide language in concurrence with the most recent state legislation and case law.

Coordination of Benefits

The fastest and most optimal recovery is using effective coordination of benefits procedures. We specialize in data mining insurance carrier enrollment, while using member enrollment interrogatories, to make sure the claim was not paid incorrectly and not billed to the incorrect carrier.