CS Recovery

Entities are constantly stretching resources to perform many different functions within the organization. Fighting fires on a daily basis leaves little time and few resources to conduct a thorough analysis of claims data. Corporate Systems' Risk Consultant practice analyzes the data as well as examines the results of data intake, utilization, and maintenance.

Recent analysis of client data indicates a significant claims management shortcoming in one specific area - recovering money.

CS RECOVERY focuses on financial leakage -- the dollars that claims administrators incorrectly pay on claims (notwithstanding that payment may be consistent with current procedures and safeguards). Financial leakage includes medical overpayment, third party subrogation, fraud, and deductible recovery error.

Medical overpayment: These are incorrect payments that arise notwithstanding the administrator's use of a medical bill re-pricing or auditing system. These systems are rule driven and prospective in nature operating primarily on a batch basis. The CS RECOVERY process is retrospective and relies on large batches of data spanning several months. It examines all available data fields at the transaction and claim level.

Third party subrogation: The same modeling technique that identifies medical overpayment also identifies third party subrogation. The CS RECOVERY process examines all fields at the claim level and looks for relationships between fields that indicate a likelihood of subrogation. This is accomplished exclusively by electronic data analysis.

Fraud: The CS RECOVERY process scores claims for fraud potential on a wholesale scale. Every claim is reviewed and, as the validity of the score is either enhanced or diminished by actual investigation, the model "learns" to improve its scoring accuracy. CS RECOVERY limits it commitment to identifying the claims and transactions that indicate fraudulent activity.

Deductible Recovery: Large and small deductible insurance programs are popular insurance coverage mechanisms for Risk Managers but present unique processing problems for insurance carriers. Deductible processing is usually manually intensive and often times results in uncollected deductibles. CS Recovery can automate the deductible billing, collection and tracking process eliminating manual effort and financial leakage.

Results, Features and Benefits of CS RECOVERY

Results:

• Recover money
• Maximize data integrity
• Reduce recovery cost
• Expedite the recovery process

Features:

• Data analysis and modeling
• Claim or transaction identification
• Recovery administration
• Accounting and reporting

Benefits:

• Access to new technology
• Derive financial value from data
• Improve data analysis
• Restore data quality

Corporate Systems, Inc., 1200 Corporate Systems Center, Amarillo, TX 79102. Tel: 806-337-3554; Fax: 806-376-4077.