Managed Care Subrogation & Oversight
For subrogation on behalf of Managed Care Organizations or oversight into your MCOs’ activities.
Unlock your full potential.
In today’s complex Medicaid healthcare landscape, Managed Care Organizations (MCOs) play a crucial role in ensuring quality care while managing billing costs. However, navigating the intricacies and responsibilities of subrogation for MCOs can be a daunting addition to their daily workloads. And on the other side, state third party liability (TPL) divisions often lack the necessary insight into their MCOs’ activities that would allow them to better leverage their services and increase recovery potential. That’s where our innovative services and custom software come in.
Our experienced TPL experts can handle all the heavy lifting of subrogation on behalf of any MCO to efficiently manage all of your encounter claims and their recovery process, ensuring optimized recoveries and federal compliance. MCOs already have all their TPL needs covered? We can still help state TPL staff with oversight! Our solutions empower TPL divisions by leveraging state-of-the-art technology to efficiently and effectively oversee their MCOs’ performance, optimize subrogation processes, and drive cost savings.
Supporting your Managed Care Organizations.
Ensure increased savings and recoveries for all. Whether you’re an MCO in need of support or a TPL division looking to improve oversight operations, dive into the world of our subrogation services and game-changing, flexible software technology that’s revolutionizing the way MCOs and state TPL divisions operate.
For Managed Care Organizations:
Subrogation On Behalf of MCOs
Our TPL experts are a dedicated team of skilled professionals who are solely focused on recovering every potential dollar for your organization. With our subrogation services, you can tap into a wealth of specialized knowledge and experience that can lead to substantial cost savings through a streamlined claim recovery process.
- Efficient claim identification and billing support for payers provides an expedited recovery process.
- Flexible and easy onboarding for new payers utilizing HIPAA compliant electronic data interchange (EDI) standards (X12 & NCPDP) for generation and processing of subrogation billing files.
- Increased recoveries through payer rejection monitoring and auditing providing a thorough analysis of each rejection to address issues that prevent reimbursement.
- Accurate and efficient payment reconciliation ensuring full circle tracking of the money repayment process to easily identify missing or incorrect payments.
- Oversight dashboards and reporting with real-time data access to monitor our billing and response processes and key results.
For Managed Care Organizations:
Subrogation On Behalf of MCOs
Our TPL experts are a dedicated team of skilled professionals who are solely focused on recovering every potential dollar for your organization. With our subrogation services, you can tap into a wealth of specialized knowledge and experience that can lead to substantial cost savings through a streamlined claim recovery process.
- Efficient claim identification and billing support for payers provides an expedited recovery process.
- Flexible and easy onboarding for new payers utilizing HIPAA compliant electronic data interchange (EDI) standards (X12 & NCPDP) for generation and processing of subrogation billing files.
- Increased recoveries through payer rejection monitoring and auditing providing a thorough analysis of each rejection to address issues that prevent reimbursement.
- Accurate and efficient payment reconciliation ensuring full circle tracking of the money repayment process to easily identify missing or incorrect payments.
- Oversight dashboards and reporting with real-time data access to monitor our billing and response processes and key results.
For State TPL Divisions:
Oversight of Managed Care Organizations
Increase transparency with your MCOs with detailed, up-to-date dashboards on all their subrogation efforts.
- Make informed, data-driven decisions from real-time information access that allows you to proactively identify patterns and issues.
- Easily communicate key information like how much money is being recovered over any given period of time to keep your team and TPL leadership informed.
- Effectively analyze opportunities for new lead generation by measuring how many encounters are being pursued for recovery.
- Oversee the entire recovery process from beginning to end with insight into how long recovery takes.
- Proactively make adjustments to your processes with a thorough understanding of how rejections are being handled by your MCOs.
- This transparency holds vendors accountable for their performance, ensuring that they are meeting contractual obligations and delivering results – positioning your state to make informed future contract negotiations.
For State TPL Divisions:
Oversight of Managed Care Organizations
Increase transparency with your MCOs with detailed, up-to-date dashboards on all their subrogation efforts.
- Make informed, data-driven decisions from real-time information access that allows you to proactively identify patterns and issues.
- Easily communicate key information like how much money is being recovered over any given period of time to keep your team and TPL leadership informed.
- Effectively analyze opportunities for new lead generation by measuring how many encounters are being pursued for recovery.
- Oversee the entire recovery process from beginning to end with insight into how long recovery takes.
- Proactively make adjustments to your processes with a thorough understanding of how rejections are being handled by your MCOs.
- This transparency holds vendors accountable for their performance, ensuring that they are meeting contractual obligations and delivering results – positioning your state to make informed future contract negotiations.
Benefits for all!
From enhancing efficiency and effectiveness to unlocking subrogation potential and driving cost avoidance, our services and oversight dashboards provide a strategic advantage for MCOs and state TPL staff alike. With custom-tailored solutions, flexibility, scalability, and peace of mind, we can propel your organization towards the most efficient subrogation processes that will help reduce your team’s workload while maximizing Medicaid recoveries.
Custom Flexibility
We understand each MCO and state face their own unique challenges and priorities. Our modular software and services offer flexibility and customization to successfully fulfill your needs.
Experienced Experts
In both TPL software and services, we have had a team entirely dedicated to third party liability since 2005. Rest assured that you’re in good hands when it comes to managing all your subrogation needs.
Increased Recoveries
No matter if you’re an MCO, part of state TPL staff, or even us at KL&A, the end goal is cost savings and increased recoveries for Medicaid. We’re here to configure a set up to help you make informed decisions that will maximize your returns.
Information Transparency
Improved communication between MCOs and state TPL divisions allows each entity to work more efficiently, proactively identify opportunities or areas for improvement, and leverage their oversight to establish effective practices together.
Modular power-ups.
Dive deeper into our subrogation and oversight modules to see how our expert services and solutions can provide a custom configuration to support your unique TPL related efforts.
HEALTH SUBROGATION
Unlock the full potential of comprehensive health subrogation billing for your fee-for-service claims.
VENDOR OVERSIGHT
Manage data from all of your TPL vendors in one centralized platform – even KL&A!
Ready for this encounter?
We’ll bring your managed care organization’s subrogation or MCO oversight to the next level.