Direct Subrogation Recovery for Self-Insured Health Plans and Fiduciary Advisors.
Prioris Technologies bypasses TPA data-extraction friction—ingesting standard 24-month stop-loss renewal CSVs and 837 EDI directly without custom TPA feeds or $5,000 extraction fees.
Direct Stop-Loss CSV & 837 EDI
No custom TPA integration or $5,000 data extraction fees. Prioris ingests standard 24-month stop-loss renewal CSVs and 837 EDI files directly.
Omitted E-Code Detection
Detects third-party trauma liability even when emergency room coders omit optional V00–Y99 external cause codes.
Mid-Tier $5k–$24k Recovery
Recovers mid-tier $5,000–$24,000 trauma claims that high-overhead call-center subrogation vendors leave unworked.
McCutchen & Montanile Audits
Audits Summary Plan Descriptions for common-fund abrogation (McCutchen) and pre-disbursement escrow freezes (Montanile).
How the Retrospective Audit Works
- Standard Data Ingestion: Provide a standard 24-month stop-loss renewal CSV or 837 EDI file alongside the plan's Summary Plan Description.
- Claim & SPD Review: Prioris flags omitted-E-code trauma claims, $5k–$24k mid-tier claims, and SPD language gaps before any notice is issued.
- Notice & Trust Recovery: Formal lien notices, carrier correspondence, and pre-disbursement escrow holds are tracked with full fiduciary audit logs.
Aligned with Plan Sponsors
- $0 Broker Commissions: Strictly compliant with ERISA § 406(b)(3).
- CAA § 202 Independence Disclosure: Full compensation transparency for plan fiduciaries.
- 80% / 20% Trust Split: 80% paid directly to the Plan Trust; 20% contingency fee.
- Zero Risk: $0 owed if $0 is recovered.
Request a Walkthrough or Sample Audit
For fiduciary advisors, benefit brokers, and self-insured plan sponsors reviewing historical claim leakage.
inquiries@prioris.tech