Case Study
Finding Savings on Claims Recovery
The client was a large, regional health insurer with an annual claims recovery spend approaching $7M, split across two providers. Corcentric was asked to identify alternate suppliers capable of providing all Claims Recovery services at a reduced rate, as the client wished to consolidate resources. The services at issue included:
- Data Mining Audits
- Coordination of Benefits – 1st Pass
- Coordination of Benefits – 2nd Pass
- DRG
- Pharmacy Audits
- Medical Chart Review
- Subrogation
- Workers Compensation
- Terminated Pharmacy
- Short-Term Disability
Corcentric conducted a wide-ranging search, identifying eight alternate suppliers. An initial round of market polling, via RFI, eliminated four. Corcentric then conducted an in-depth RFP with the four remaining alternates and the two incumbents. After exhaustive polling and supplier scorecarding, Corcentric identified a single alternate supplier capable of providing all requested services at a savings of more than 30%, and negotiated a contract with them on behalf of the client. We then oversaw the supplier changeover and project implementation.
The project was a success and Corcentric maintains a working relationship with the client today.
