Subrogation Case Identification Solution
Identify more high-value subrogation opportunities to improve recoveries, focus resources, and streamline operations.
Identify more subrogation cases that lead to recoveries
Successful subrogation recovery starts with identifying the right opportunities. Our subrogation analytics help health plans uncover claims payments where another party may be financially responsible, while data validation and our proprietary intelligence tools help turn those findings into actionable, prioritized leads. This helps your team direct attention to cases with stronger recovery potential and improve recovery performance.
Lines of business:
- Commercial
- Medicare Advantage
- Medicaid
- Federal employee
Audience:
- Payers
Strengthen case identification from the start
Bring greater precision and flexibility to case identification with an approach that combines predictive modeling, data quality validation, and configurable workflows. Together, these capabilities help your team identify potential cases efficiently and support your operational and engagement goals.
Identify subrogation cases faster
Using predictive analytics, automated data matching, and healthcare-specific subrogation software, we identify subrogation cases faster and more accurately.
Prioritize stronger recovery opportunities
Every lead undergoes data quality validation before delivery, helping your team focus on claims with a greater likelihood of recovery.
Implement more flexible member and provider engagement
Our configurable workflows support your operational goals and help create a more streamlined experience for members and providers.
Inside our Subrogation Case Identification solution
Our technology-enabled subrogation case identification solution combines predictive analytics, real-time data matching, and recovery intelligence tools to help plans uncover more subrogation opportunities.
Data integrity review
We review data for gaps or inconsistencies that could affect case identification.
Prioritized leads
We validate and prioritize leads so your team can focus on stronger recovery opportunities.
Real-time data matching
We continuously compare available data to uncover additional subrogation opportunities.
Configurable member engagement
We tailor outreach workflows to support your operational needs and member experience goals.
Nonresponder program
We help identify additional opportunities when member outreach does not receive a response.
Actionable reporting
We provide clear reporting and insights to help your team track and act on recovery opportunities.
How our subrogation identification process works
Review data integrity
We evaluate claims data for inconsistencies that could affect subrogation recovery performance, including inaccurate addresses, eligibility gaps, and demographic mismatches.
Identify subrogation cases
We use predictive analytics and proprietary databases to identify potential cases and responsible third parties while reducing reliance on member questionnaires.
Investigate liability opportunities
Our subrogation services specialists gather relevant case information and determine liability.
Prioritize high-value recovery opportunities
We prioritize actionable leads based on recovery potential, helping your team focus on opportunities with greater financial impact.
Connect with our subrogation experts
Contact us to learn how our subrogation solutions help health plans identify more recovery opportunities, improve operational efficiency, and strengthen recovery performance through advanced analytics and automation.
Explore related subrogation solutions
Complete a questionnaire or refer a case
Use the tools below to complete a subrogation questionnaire, refer a new case, or access information about our healthcare subrogation process.
Questionnaire
Received a questionnaire in the mail?
Submit your information securely online or review other response options.
Case referral
Want to refer a new case to us?
Submit your information online and find additional options here.
Frequently asked questions about subrogation recovery
Are you a health plan member seeking subrogation support?
Why did I receive a letter from Carelon about a subrogation questionnaire?
If you received a call, letter, email, or text from Carelon related to a subrogation questionnaire, we need additional information to determine if someone else should be financially responsible for your treatment.
For more information about a subrogation request, call the number listed on the subrogation letter you received.
You can also contact the Member Services number on your member ID card or use the member support contact information provided by your health plan.