Case Study: Wisconsin Medicare and Medicaid administrator achieves 85%+ response rate and $10 PMPY recoveries with SCIO Health Analytics' outsourced TPL solution

Medicare and Medicaid Administrator - Customer Case Study

Medicare and Medicaid Administrator, a small Wisconsin plan with about 20,000 members (many dual-eligible), lacked in‑house legal resources and struggled with a transient Medicaid population and low outreach response. Pressured by the State of Wisconsin to proactively identify third‑party liability, the administrator chose to outsource to SCIO Health Analytics, using its MY SOCRATES® subrogation software and full‑service subrogation outsourcing.

SCIO Health Analytics implemented end‑to‑end subrogation services — multi‑dimensional data mining for identification, automated mailing and investigation cycles, paperless case management with in‑house attorneys, recovery processing and a 24/7 secure web portal for transparency. The engagement produced an overall response rate greater than 85%, recoveries exceeding $10 PMPY in 2013, monthly recovery and reporting packages, and materially alleviated the customer’s staffing and legal burdens.