Plan Document Risk Assessment
Confront the issues that impact our industry by addressing conflicts that threaten plan operations and viability, coordinating relationships, and providing guidance.
The Phia Group is the industry’s premier self-funding expert. Collaboration between our organizations adds value to all entities involved, and ensures satisfaction amongst those we service. We understand that our success is directly correlated with that of our clients. We are stationed at the front line to ensure the industry is strong, growing, and ripe with opportunity. Our involvement as both advocates and leaders in the industry is unique to The Phia Group; no other firm is as active in facing its clients’ issues.
Independent Consultation & Evaluation (ICE)
Plan complexity in the self-funded world is on the rise. Our team of renowned attorneys and paralegals provide a wide spectrum of consulting services to the ever changing health plan industry, dealing with any and all legal and regulatory compliance issues. Compliance concerns, multifaceted factual dilemmas, business disputes, and any other situation that involves the administration of a self-funded health plan are provided with assessment of the issues involved, necessary legal research, discussion of best practices, and unrivaled guidance.
Claim Assessment & Analysis
We obtain facts, documentation and answers requisite to the successful processing of claims. The team also reviews claim scenarios upon request, aids in determining proper claims adjudication, and assists with stop-loss submissions and appeals.
Third Party Agreement Review, Revision, Drafting & Templates
From Administrative Service Agreements to HIPAA Business Associate Agreements; from network contracts to vendor statements of work; whenever a benefit plan or an entity servicing such a plan finds itself with a contract, proposal, or agreement, they can rely on us to provide review, commentary, and proposed revisions prior to executing the deal.
General Plan Regulatory Inquiries & Legal Compliance
Sponsoring and administering a self-funded health plan has become a legal process. Between regulations, statutes, contracts, and case precedent, it is harder than ever to navigate the legal complexities of self-funding a health plan. We provide consultation and support to plan sponsors and administrators every step of the way – from plan establishment, to licensing, to administration, to conflict resolution.