Data-Driven Multi-Claim Hospital Settlement

This negotiation involved two related inpatient claims for the same patient and provider. Phia adopted a strategic approach by linking both claims into a single settlement and proposing a uniform percentage reduction to incentivize agreement.

 

To support the recommended settlement, Phia developed a comprehensive substantiation package leveraging industry-standard data, including market rates, Medicare multiples, and private commercial reimbursement studies. Phia further used the hospital’s publicly reported financial data to demonstrate that the negotiated payment exceeded the provider’s average commercial reimbursement—strengthening the case for acceptance.

 

Both claims were successfully resolved together, providing defensible savings supported by robust reimbursement benchmarks.

 

By partnering with The Phia Group, the client realized $60,000 in savings through a coordinated two-claim settlement.