Case Study: Blue Cross Blue Shield achieves 85% response rate and $3.5M in recoveries with SCIO Health Analytics

Blue Cross Blue Shield - Customer Case Study

Blue Cross Blue Shield’s Mid-Atlantic affiliate (≈500,000 members) faced ineffective subrogation outreach—only a single questionnaire mailing, no tracking or follow-up, outdated claims-identification rules, low response rates, recurring audit findings, and an overwhelmed OPL department. SCIO Health Analytics was engaged, bringing a co-sourcing approach and its MY SOCRATES® subrogation platform to address these gaps.

SCIO Health Analytics implemented customized member questionnaires, automated mailing cycles with response tracking, improved data‑mining and identification algorithms, and remote access to MY SOCRATES®. The program drove an overall response rate above 85%, delivered $3.5 million in recoveries in 2012, and a two‑year retrospective review uncovered an additional $1.5 million in missed recoveries, with SCIO identifying and investigating cases for the plan to manage and recover.

Blue Cross Blue Shield