Reference-Based Pricing Explained
Offer flexible service options driven by client needs, innovative methods to identify more opportunities and master applicable laws, yielding results unmatched by anyone else.
- Industry Tested Plan Language and Contract Expertise
- Accurate Claim Cost Assessments and Pricing
- Signed Provider Agreements to Prevent Balance Billing
- Fees Apply Only to True Savings
Most benefit plans will pay excessive amounts to providers that are out of network or in a wrap network. With The Phia Group, payers can make reasonable payments, enjoying incredible savings and still protecting their participants from balance-billing. Replace costly out-of-network and wrap network claims, through the use of innovative language, legal resources and best-in-class pricing options.
Claim Negotiation & Signoff (CNS)
When paying for healthcare, consumers should have the right to secure fair rates without the threat of balance-billing. Utilizing a comprehensive program that combines targeted data, industry expertise, and negotiation by attorneys, our clients enjoy true savings and protection through provider signed agreements.
Frequently Asked Questions About Claim Negotiation:
What is 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 claim negotiation program that combines targeted data, industry expertise, and attorney support, our clients enjoy true savings and protection through signed agreements.
Can we utilize CNS but continue to use other vendors for other claims as well?
Yes. Use of CNS is non-exclusive. While The Phia Group is confident that CNS provides the best savings in the marketplace, clients of this service are free to continue using other vendors for claim negotiations as they see fit. Claims are subject to the CNS service only when a client wants them to be.
What is The Phia Group’s fee if a provider refuses to negotiate?
Nothing. If The Phia Group is unable to provide any value for a given claim, no fee is collected on that claim, since there has been no savings.
Are there any claim types or amounts you can’t or won’t negotiate?
The Phia Group specializes in inpatient and implant claims, but all claim types are potentially negotiable. The Phia Group even offers to negotiate in-network claims. Out-of-network claims are subject to a minimum threshold of $10,000, and in-network claims are typically subject to a minimum threshold of $50,000.
Are negotiation fees reimbursable by stop-loss?
In general, yes, but it varies by carrier. We always advise that the group discuss this with the plan’s carrier.
Can you describe the life-cycle of a claim?
The Phia Group welcomes all claim negotiation submissions to ProviderRelations@phiagroup.com. The Phia Group’s experts will perform a review of the claim and be in touch with any questions or initial thoughts, and The Phia Group will then engage the provider toward a resolution. No settlement will be agreed upon without the client’s consent, and the client will regularly be kept up to date with status reports (typically every two to three days). Upon receipt of a signed agreement by the provider, The Phia Group will provide the client with a repricing sheet (showing the claim, savings, and fee details) and an invoice.