LIABILITY INSURER AND HEALTH PLAN DATA EXCHANGE

摘要

A data information exchange, which accesses data from liability insurers and health plans, manages the data and allows health plans to identify when their plan participants are third party claimants in injury claims. In another aspect, subrogation entities access the data information exchange in order to perform subrogation operations for the health plans, relating to the health plan's participants. In another aspect, coordination of benefit recovery entities access the data information exchange in order to perform recovery operations for the health plans, relating to health providers which rendered services to participants of the health plans.

主权项

1. A non-transitory tangible computer readable medium containing a series of instructions, which when executed by one or more processors, causes the one or more processors to perform an information exchange process comprising:
i) comparing injured claimant data records and plan participant data records, the injured claimant data records containing identifying demographic information about third party claimants, the injured claimant data records created by liability insurers after receiving injury claims from third party claimants, the plan participant data records containing identifying demographic information about participants of health plans, the plan participant data records created by the health plans; and ii) creating matched data records by identifying a match of information shared between injured claimant data records and plan participant data records, the match indicating individuals who are both third party claimants and participants of the health plans.