In analyzing claims processing software, it has become abundantly clear that no matter how many algorithms, intuitive data mining processes and fancy bells and whistles are introduced, the very medium of using the health provider’s claims data as the major source of information for identifying the existence of policyholder injury claims, is extremely limiting.

Many complications of this system include:

• A heavy dependence on the health provider’s administrative staff properly coding all patient records.
  
  
• An inconsistency and lack of comprehensiveness within many health provider’s patient intake forms.
  
  
• Patient accuracy in truthfully answering the provider’s form questions.
  
  
• The use of indirect identifying factors, such as more than 3,700 diagnoses and procedure codes that lead to many false positives and large inefficiencies in subrogation identification.
  
  
• An inability for health providers to know and pass on situations when their patients choose to file injury claims after the time of treatment and patient information collection by the provider.
  
  
• A common failure for health insurers and their outsourced claims vendors to miss subrogatable torts, such as class-action lawsuits and medical malpractice.
  
  
• That even when leads are identified, they still are ONLY indirect leads, needing manual follow-up.
  
  
• Delayed notification from the policyholder, resulting in delayed subrogation identification and claim filing.

SubroShare® is an innovation that 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 in-network 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.
As a result, this data not only provides unique and non-duplicative injury claim finds, but is directly identifying. This means that the new data does not require many of the manual follow-up investigation procedures, such as sending letters and making phone calls, which themselves can lead to false positives and dead end results.

The new data medium, known as a Certified Recovery Report®(CRR) stems from health providers passing on part of the data they have, whenever they receive a release-of-information (ROI) request for patient records from a patient or attorney. This ROI data is HIPAA-compliant, as it falls under the provision of PAYMENT and directs health payers, TPAs and self-funded plan sponsors, known as Subscriber Entities (SEs), to know which of their policyholders are in injury claims, as well as providing the contact information for the attorneys involved in their injury claim.