Phia Unwrapped – Protection from Costly Out-of-Network and Wrap Claims
Your Comprehensive and CARING Out-of-Network Solution
Joined The Phia Group in 2006
The Phia Group replaces wrap network access to support non-network payment methodologies. Phia serves as an execution engine—implementing the reimbursement methodologies defined by TPAs and plan sponsors. Whether those methodologies are based on Medicare benchmarks, usual and customary rates, or other standards, Phia calculates, supports, and defends those determinations through expert negotiation, balance bill support and documentation.
Looking for Claim Negotiation & Signoff (CNS) or No Surprises Act (NSA) services? The Phia Group has you covered.
Phia Ignite Repricing Engine Technology
With Phia Ignite, we implement complex multi-factor methodologies as defined by our clients to help them achieve maximum savings for their health plans.
Our Team
Certified Medical Coders
Clinical Staff
Attorneys
Industry Experts
Our Technology
Provider Data and Selection Technology
Benchmarking
All-Encompassing Data
Provider Quality Metrics
Phia Ignite gap-filling strategy helps employer plans determine payments for claims in locations where benchmarks and rates are usually unavailable and can integrate seamlessly across platforms.
Resolve Out-of-Network Claims and Those Arising from Balance Billing
The Phia Group combines everything needed to improve your health plan cost containment while passionately supporting people every step of the way. We resolve balance bills with independent legal representation to ensure no one is left alone.
Higher
Savings
Lower
Costs
Unmatched
Experience
Phia Unwrapped Savings in Action
The Phia Group secured over $1.2 million in savings on total billed charges exceeding $3 million and ensured there would be no future appeals or denials regarding the treatment at this facility.
How Phia Unwrapped Works For You
Average Savings*
More NSA Savings
Than the Industry
Average**
More NSA Wins
Than the Industry
Average**
*Subject to claim mix and provider billing practices
**Based on an industry study of Independent Dispute Resolution (IDR) decisions
Leigh Ann Furr
Director of Compliance
Angle Health
“There are so many out-of-network vendors, but none protect the member and take care of all the NSA regulatory requirements like The Phia Group. They have the most recent and relevant technology, they are compliance experts, AND they care for my members. The plan saves money and the members are protected.”
Caroline Fraker
President, COO & CPO
MedBen
"We have worked with many vendors that offer out-of-network repricing services, but Unwrapped from The Phia Group is best in class in terms of savings and superior when it comes to compliance and savings. Most importantly, they are outstanding at navigating the intricacies of the No Surprises Act open negotiation and IDR processes, saving our clients money and frustration."
Charlene Zielinski
Chief Client Services Officer
Nova Healthcare Administrators
"We have worked with The Phia Group for many years for subrogation and compliance work, and so we were curious about their out-of-network repricing service called Unwrapped. Our client base is focused on savings but also very protective of their members being balance billed. For these reasons, we selected The Phia Group’s Unwrapped program as they have been balance bill experts for over 10 years. We are astonished with the savings and Phia’s ability to manage any disputes quickly and efficiently."
The Phia Group’s CNS and NSA Support Services
Claim Negotiation & Signoff
When paying for healthcare, consumers should have the right to secure fair rates without the threat of balance billing. Utilizing a comprehensive program combining targeted data, industry expertise, and negotiation by attorneys, our clients gain savings and protection through provider-signed agreements. CNS can be used to negotiate any non-contracted bill for medical services, regardless of whether the effort is being made on behalf of a health plan, administrator, or carrier.
No Surprises Act Support Service
The Phia Group’s NSA service is available to users of both Unwrapped and Balance Bill Resolution, and includes support for payment and open negotiations, as well as formal dispute resolution triage and navigation. With years of experience in balance bill resolution, litigation, and nationwide negotiations, we provide NSA payment analysis and recommendations including an initial payment, QPA support, and multiple factors to utilize in open negotiations.
What You Can Expect with The Phia Group
Innovative, industry-leading plan language that flawlessly supports the program.
Plan defense and advocacy with CARE at the center of everything we do.
Replacement of unfavorable wrap networks and ambiguous out-of-network pricing.
Plan language review from the industry experts in compliance.
NSA open negotiation and Independent Dispute Resolution (IDR) processes led by attorneys.
The Phia Group is here to protect you against unjust out-of-network claims, wrap claims costs, and balance billing.
Want to Learn More About What Our Other Services Can Do For You?
The Phia Ecosystem
Our services work together—or individually—to help you recognize your full cost containment potential.
Unwrapped FAQs
Phia Unwrapped is a way to help protect forward-thinking plan sponsors against unjust out-of-network and wrap claim costs. With Phia Unwrapped, The Phia Group replaces wrap network access and modifies out-of-network payment methodologies, securing payable amounts that are unbeatably low, based upon fair market parameters.
No. Phia Unwrapped replaces traditional out-of-network, wrap, and extender network pricing, regardless of claim size.
The claims flow of Phia Unwrapped is designed to feel exactly like a network. Through an 837 file, The Phia Group ensures accurate claims repricing, which is then returned to the TPA for regular processing.
Yes. For non-network claims, the plan document is the “supreme law of the land” with respect to the plan’s rights, so the plan document must be amended to reflect the plan’s payment methodology. The plan’s ability to defend its payment depends on the rights the plan has given itself.
No. The fee for this service is only a percentage of savings achieved on those claims. There are no hidden fees and no charges for “suggested” but unrealized savings.
Since Phia Unwrapped is designed only for non-contracted claims where the plan does have a primary network structure, there are no concerns regarding compliance. Network adequacy is not an issue for Phia Unwrapped, since users of this service will have dedicated primary networks.
When Plans Win, So Do Families
We believe that everyone should have access to high-quality and justifiably priced care.
Contact us today to get started.
