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FIRST, WE RECOGNIZED THAT THERE WAS A CONNECTION OF DATA MISSING. ONE THAT COULD VERY EASILY POINT OUT MANY MISSING TPL CLAIMS.

THEN WE REALIZED THIS WAS A PERFECT OPPORTUNITY TO BRING FORTH A NEW TOOL, OFFERING A TRANSPARENCY BETWEEN HEALTH PAYERS AND NETWORK PROVIDER RECORD DEPARTMENTS. AN EASY-TO-IMPLEMENT ADD-ON, TO A PAYER'S EXISTING CLAIM OPERATIONS, VENDORS AND SOFTWARE.
 

SubroShare® is a patent-pending model, which brings unique and direct identification of third party cases right to the health insurer through a new technology and strategy known as Collaborative Subrogation®. This allows for health providers to submit previously untapped, non-billing patient data, which clues the payers into new injury claim finds, they would have missed with existing operations.

The new proprietary data, known as Certified Recovery Reports®(CRRs) stems from health providers passing on part of the data they collect, whenever they receive a release-of-information (ROI) request for patient records from a patient or attorney. This model is employed in two different variations, depending on whether the provider network is the payer-direct or contractually outsourced from a network vendor.



MODEL 1
PAYER-CENTRIC PROVIDER NETWORK IMPLEMENTATION
 
 
Implementation Steps for MODEL 1 (example)

  1. An existing health payer client of SubroShare® sends out a mandatory joining notice to 100,000 of their in-network providers. Mandatory joining of SubroShare is accomplished via negative enrollment or active provider communication; both with implementation of penalties, if non-compliance arises.


  2. Health providers join SubroShare®, either through negative or mandated active enrollment. In this example, although
    all providers have joined, there is only a 25% compliance with those providers who actively participate.


  3. Of the 25,000 participating health providers, each month 20% of the providers receive just a single unique patient record
    request, which would have not been known by the patient's health payer. Thereafter, these providers submit a total of 5,000
    new and unique ROI data submissions to SubroShare, via a one or two page fax. This is ONLY for those patient and legal
    record requests, which have been affirmed as necessary to submit to SubroShare.


  4. The health payer client's claims department or outsourced claims vendor logs into their account at SubroShare and performs a simple web-based search. This is directly-identifying TPL data, with a cost to download of approximatley $517,000.


  5. Of the 5,000 unique TPL claims cases, the average value for auto, non-auto tort and work comp is $3,500 per case. This amounts to new revenue totaling $16.9 million per month/$203 million per year OVER AND ABOVE what your claims operations and outsourced vendors have brought in.

  6. Upon receiving data from the claims department, the payer's provider relations department administrates compliance amongst its providers.




MODEL 2
OUTSOURCED PROVIDER NETWORK IMPLEMENTATION
 
 
Implementation Steps for MODEL 2 (example)

  1. An existing outsourced provider network (e.g. PPO, Re-Pricing Network, Carve-Out Network, Welfare Plan, TPA, etc.) sends out a mandatory joining notice to 100,000 of their in-network providers. Mandatory joining of SubroShare is accomplished via negative enrollment or active provider communication; both with implementation of penalties, if non-compliance arises.


  2. Health providers join SubroShare®, either through negative or mandated active enrollment. In this example, although
    all providers have joined, there is only a 35% compliance with those providers who actively participate.


  3. The outsourced provider network establishes a relationship with a single health payer client, whereby privately there is an agreement stipulating improved valuation for the outsourced network, by its payer client, per ability to receive new TPL data from such providers.


  4. Of the 35,000 participating health providers, each month 20% of the providers receive just a single unique patient record
    request, which would have not been known by the patient's health payer. Thereafter, these providers submit a total of 7,000
    new and unique ROI data submissions to SubroShare, via a one or two page fax. This is ONLY for those patient and legal
    record requests, which have been affirmed as necessary to submit to SubroShare.


  5. The health payer client's claims department or outsourced claims vendor logs into their account at SubroShare and performs a simple web-based search. This is directly-identifying TPL data, with a cost to download of approximatley $724,000.


  6. Of the 7,000 unique TPL claims cases, the average value for auto, non-auto tort and work comp is $3,500 per case. This amounts to new revenue totaling $23.7 million per month/$285 million per year OVER AND ABOVE what your claims operations and outsourced vendors have brought in.

  7. Upon receiving data from SubroShare®, the outsourced provider administrates compliance amongst its providers.