The Phia Group is now a part of the Alliance group purchasing organization
The Phia Group
03/19/2018
The Phia Group is now a part of the Alliance GPO. Download their GPO contract for details on available discounts, savings and value-added opportunities. Visit their vendor directory listing to learn more and see a list of their current Alliance customers.
The Phia Group, LLC is a premier provider of cost containment and compliance services that has, since 1999, provided innovative strategies to the health insurance industry. The Phia Group’s data driven solutions, industry insight and legal expertise are unrivaled. Founded in 1999 by friends Adam Russo and Michael Branco, The Phia Group has evolved from its humble beginnings to a thriving company, consisting of numerous staff attorneys and offices located across the country. The Phia Group services clients in all 50 states, representing millions of lives.
The Phia Group’s Mission is to reduce the cost of healthcare through innovative technologies, legal expertise, and focused, flexible customer service. By providing the industry with best practices and staying true to a forward thinking methodology, The Phia Group boasts an all-encompassing cost containment program for the ever-changing healthcare industry.
The Phia Group’s vision, employed to meet its mission, is to create and enhance innovative tools for cost savings and opportunities through expert consultation, plan document services, claims recovery, negotiation, and advocacy to defend the plan. These pillars are the legs upon which The Phia Group stands, and are necessary to be the leading cost containment and consulting firm in the health insurance industry.
What Is The Phia Group Doing for Health Plan Alliance Members?
The Phia Group is now able to offer its premier service offerings to Health Plan Alliance Members, including the following: (i) Subrogation and Recovery Services; (ii) Plan Appointed Claim Evaluator® (PACE) Service; (iii) Independent Consultation and Evaluation (ICE) Service; (iv) Phia Unwrapped; (v) Claim Negotiation and Signoff (CNS); and (vi) Plan Drafting Services.
The Phia Group’s Subrogation and Recovery Service utilizes innovative methods to identify more opportunities and enhance recoveries to put dollars back into a health plan, where those dollars belong. We are able to identify an average of one case for every 150 lives, which is three times greater than the industry average. Additionally, The Phia Group’s customized approach to subrogation and recovery means that we are able to approach the recovery process through multifaceted investigation techniques and by cross-referencing claims and litigation databases for detailed investigations, meaning we can work cases with minimal member disruption. The Phia Group boasts a robust and proprietary data scrubbing platform known as The Phia System™. This platform allows for maximum case identification through data scrubbing a full claims feed. If this is not the desired approach, clients can always refer cases to us, on a case-by-case basis.
Our Plan Appointed Claim Evaluator® (PACE) Service allows for The Phia Group to assume fiduciary responsibility as it relates to the handling of final, internal claim appeals, sometimes called “second level appeals.” This Service includes a complimentary plan document review, focused on compliance and appeals concerns, along with a written gap-review, analyzing the plan document alongside the stop-loss policy. Also, as part of this service, we stand behind our written directive, issued when we handle a second level appeal, and we will support our directive in the face of external appeal and judicial scrutiny. Additionally, and fully included with the PACE Service, we will facilitate the IRO external review process, and we will also spearhead appeals to stop-loss carriers if and when applicable.
The Independent Consultation and Evaluation (ICE) Service offers unlimited access to The Phia Group’s attorneys for consultation regarding issues such as understanding the application of federal regulations (i.e. ACA, ERISA, HIPAA, Medicare, GINA, COBRA, ADA), the application of state regulations, general compliance issues, specific claim reviews, contract reviews and more.
Our premier out-of-network solution, Phia Unwrapped, provides and alternate pricing methodology for out-of-network claims incurred by a plan. Phia Unwrapped will replace any wrap network previously used and will provide superior cost savings. Phia Unwrapped provides upfront consultation on plan design and repricing thresholds that will be successful for the plan. Additionally, Phia Unwrapped will minimize disruption to your member population through patient advocacy and balance billing defense.
Claim Negotiation and Signoff (CNS) is a comprehensive program that combines targeted data, industry expertise, and negotiation by attorneys, to achieve signoff and resolution on both in-network and out-of-network claims at the request and referral of a plan.
Our Plan Drafting Services allow you to develop your plan document utilizing The Phia Group’s team of plan drafting experts. The Phia Group can draft, review, revise, certify, provide gap-free analysis, and collaborate on any types of plan documents. Additionally, The Phia Group has created plan document language that has become the industry standard. The verbiage maintained by our team of attorneys not only provides language compliant with all regulations, but also implements cost containment provisions. Outside of ad-hoc plan drafting projects, you may wish to utilize Phia Document Management (PDM) which promotes our mission to provide industry best practices and an all-encompassing cost containment program while also providing the flexibility to customize plan documents.
PDM is an online plan drafting software that requires no installation or upgrades to a user’s method of interfacing with the software, i.e. computer, laptop, smart phone, or tablet. The user will be provided a secure link to the PDM software website and login credentials and will have the ability to access the website at any time, so long as they have internet connection.
Ultimately, The Phia Group offers a unique approach with customized solutions, as described above, and based on the needs of the businesses it services. It is the mission of The Phia Group to reduce the cost of healthcare, empower plans, and ensure mutual success and growth of every partner The Phia Group works with.