Protect - PLAN APPOINTED CLAIM EVALUATOR® (PACE)

Protect forward-thinking plan sponsors against fiduciary liability, and plan members from balance-billing and collections activities.

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Plan Appointed Claim Evaluator® (PACE) 

The self-funded industry already turns to The Phia Group for our legal and analytical expertise. Now, acting as your PACE, we handle final internal appeals as a fiduciary while defending our decisions in the face of external appeal and judicial scrutiny. The Phia Group will also facilitate the retention of Independent Review Organizations (IRO) in accordance with applicable law, help facilitate the IRO external appeal process, and coordinate with stop-loss – including appealing denials by the excess carrier if and when applicable.  With the PACE program, benefit plans receive:

  • Plan Document Review to Ensure Compliance and PACE Readiness
  • Multifaceted Implementation Ensures Awareness and Seamless Utilization
  • Advanced Level Webinars Presented Exclusively for PACE Clients
  • Assessment of Final Internal Appeals and Directives from a Fiduciary
  • Unsurpassed Legal Analysis, Clinical Review, and Access to URAC-Accredited IROs
  • The PACE Ensures Claims Are Processed in Accordance with Plan Terms
  • Relevant Stop-Loss Policies and Network Contracts Are Reviewed 
  • TPAs Facilitating the PACE Service Receive an Administrative PEPM