cortexsubro is the premier medical claims subrogation management platform designed expressly for government-regulated health plans. cortexsubro is built atop cortexanalytics’ cortexETL, the only Extract, Transform, and Load solution that facilitates user self-service loading of all data files commonly used by Medicare Advantage Organizations, Medicaid Managed Care Organizations, ACOs, and ACA Issuers.

cortexsubro’s unique features allows health plan and law firm users to create episodes of care beginning with the tort, accident, or other event that initially caused the injury or illness, and then uses predictive analytics to predict future medical expenses from the multi-million life MarketScan^® Commercial, Medicare, and Medicaid Claims and Encounter Database built into cortexanalytics platform.  Predictions of future medical expenses, controlling for the victim’s underlying health conditions using comprehensive risk adjustment and related analytical methods, helps plaintiff’s counsel maximize the recovery of monies from primary payers for both past and future medical expenses.  It also ensures that sufficient funds are available should a State Medicaid program attempt to recover future medical expenses pursuant to the Supreme Court’s recent opinion in Gallardo v. Marstiller  (963 F. 3d 1167, GALLARDO v. MARSTILLER | Supreme Court | US Law | LII / Legal Information Institute (cornell.edu)

If you are a Medicare Advantage Organization, a Medicaid Managed Care plan, or a representative of one, don’t turn your subrogation files over to some debt collector who is just going to file “fishing expedition” lawsuits in federal court, citing the Medicare Secondary Payer Act and its double-damages recovery provision.  These shotgun pleadings almost always end up getting dismissed (typically under Rule 12(b)(6)). cortexsubro will instead tell you the current and future value of subrogated liability, helping you select the cases best suited to take to trial and/or to negotiate a settlement in the best interests of all parties.