Coordinated care organization faces subrogation lien perfection challenges

Challenge

A coordinated care organization handling Medicare and Medicaid claims needed support when their state enacted a new law mandating a specific and detailed process to perfect liens. Any Medicare and Medicaid payer that did not adhere to the specific requirements mandated by the state would be legally unable to make recoveries. Our client did not have the resources to handle the process and was in danger of losing subrogation opportunities and significant financial losses if liens could not be perfected.

Human ingenuity

Without any existing system in place, the client needed more than a solution – they needed knowledge, training, the development of a fully new process, resources, and a seamless execution. The client needed an active partner to take full control of the project. EXL Health embraced the challenge. To fully understand the project, EXL Health conducted thorough research and extensive discussions with the client, the state and coordinating stakeholders to fully understand the objectives, long-term needs, and regulatory requirements. As subject matter experts, EXL determined the right people, processes, and technology to address all needs, streamlining and implementing efficiencies for the detailed lien perfection process. Leveraging human ingenuity, our deep domain expertise, and highly comprehensive solutioning experience, EXL Health created and implemented an agile solution that met all client and regulatory requirements.

Outcomes

Liens are now being perfected, and client did not lose any recovery opportunities. EXL Health also created additional value for the client by taking over duties that were previously handled in-house. We provided two FTEs who have full access to the client system and communicate directly with the state, saving the client resources, time, and money.

Between 2018-2021, EXL Health achieved significant results for the client: