The Phia Group Blog

By: Kate MacDonald These days, artificial intelligence, or AI, has become increasingly incorporated into nearly all areas of our lives. You cannot turn a corner without encountering it, from the smartwatch strapped on your wrist relaying sleep metrics to your…

By: David Ostrowsky While many healthcare organizations have lauded AI for its inherent potential to improve the US healthcare system by expediting claim review decisions, generating summaries of doctors’ conversation with patients, and analyzing scans and X-rays among other functions,…

By: Stewart P. Miller, Esq. Every healthcare subrogation professional knows the file. Medical claims have been paying for months, and nothing initially distinguishes them from thousands of other claims in the system. Then a questionnaire, diagnosis code, provider note, or…

By: David Ostrowsky The No Surprises Act (NSA) established a federal framework intended to protect patients from surprise medical bills while also providing a structured process for resolving payment disputes between payers and out-of-network providers and facilities. As the volume…

By: Matthew Kyle Health plans are facing increasing scrutiny over claim denials as new data shows that external independent review organizations overturn more than half of disputed medical, mental health, and surgical claims. Researchers found that overturn rates in New…

By: Lisa Hill, Esq. Denied claims discussions often focus on those things that should be examined, evaluated, and documented during that process. This is not another claim denial review but rather a look at how disputed denied claims might affect…