Reduce Your Risk and Take Back Financial Stability and Confidence
The Phia Group ensures that all relevant materials from plan documents to stop-loss policies align for maximum clarity and regulatory compliance with PACE®.
Appeals are expensive. The average cost of an external appeal to an IRO is $1,000 with the amount at stake per appeal growing by nearly 100% each year.
No Medical Necessity
36%
Experimental and Investigational
35%
Off-Label Use of RX
15%
Other Exclusions
14%
The Phia Group utilizes PATS, our proprietary state-of-the-art appeals technology, to ensure that nothing is overlooked in the decision-making process. Our subject matter experts provide:
Plan document review to ensure compliance and PACE® readiness.
Assurance that claims are processed in accordance with plan terms.
Multifaceted implementation to ensure awareness and seamless utilization.
Review of all relevant stop-loss policies and network contracts.
Advanced-level webinars, presented exclusively for PACE® clients.
An administrative PEPM for any TPAs facilitating PACE® services.
Unsurpassed legal analysis, clinical review, and access to URAC-Accredited IROs.
Appeals management with objective and dedicated oversight by experienced professionals.
The Phia Group is here to help you reduce your financial risk and take back stability and confidence with PACE®.
"At Cobalt Benefits Group, we are fixated on cost, quality and member experience. And The Phia Group, through their PACE® product, is fundamental to having protections in place for the customer and their bottom line, as well as individual exposure to the health insurance market. They are experts, and they provide a layer of protection for our customers that we think is a market differentiation for us.”
Bill Meehan
President and CEO Cobalt Benefits Group
Our services work together—or individually—to help you recognize your full cost containment potential.
Your Partner for B2B Compliance and Business Solutions
The Key to Unlocking Your Full Recovery Potential
Industry-Renowned Protection Against Fiduciary Liability Arising from Final Level Appeals
Comprehensive and Technology-Driven Out-of-Network Repricing
Next Level Reference-Based Pricing with Quality Care and Fair Pricing Done Your Way
Joined The Phia Group in 2013
We believe that everyone should have access to high-quality and justifiably priced care.Contact us today to get started.