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| Claims Recovery Services | |
| Plan Document Services | |
| Consulting & Special Services |
Claims Recovery Services
The Phia Group’s acclaimed “Passion for Subro” is recognizable throughout the health insurance industry. Our mission to reduce the cost of clients’ health plans by utilization of innovative technology, legal expertise, and personalized service remains unrivaled. To emphasize our commitment to this mission and leadership role within the industry, The Phia Group invests in expertise by leading the nation in the number of Certified Subrogation Recovery Professionals working on clients’ cases. Our subrogation cases identified and overall recovery numbers are unmatched by anyone in the industry. Subrogation and Right of Reimbursement By utilizing The Phia System™ technology, The Phia Group’s internal review provided by our experienced case evaluators and The Phia Group’s training program, potential recovery cases are identified in much higher volumes than industry norms. With each case identified, The Phia Group examines the facts, obtains all the details, and consults with clients in determining the best course of action to maximize recoveries. Attorney Consultation and Defense Arguments to reduce or eliminate plan rights must be countered by experienced attorneys who comprehend recovery laws and strategize options to ensure subrogation rights are protected. The Phia Group’s attorneys provide this expertise by mastering the obscure subrogation and reimbursement laws of all fifty States, as well as the Federal Circuits. In addition to this expertise, our unique law firm partnership allows a seamless transition for cases requiring litigation, without additional expense to clients. Second Pass Recovery Audit In most payor organizations, claim recovery occurs through internal or outsourcing processes; however, it is evident that most of these payors overlook many claim recovery opportunities. It is never too late to recoup money from these missed subrogation claims. To minimize lost opportunities, The Phia Group will review clients’ past paid claims data with our proprietary software, The Phia System™, and uncover subrogation cases previously overlooked. A comprehensive analysis detailing potential recovery cases and an estimate of expected savings are also provided. Overpayment Recovery The Phia Group will discover and pursue reimbursement of paid claims that are the responsibility of another party, should have been excluded by the plan resulting in possible duplicate payments to a provider, or overpaid for any other reason. Overpayments include processing errors, fraudulent claims, duplicate payments, unreasonable charges (The Phia Group's response to never events), dependent eligibility audits and post-termination charges paid. Coordination of Benefits The Phia Group analyzes the applicable coordination of benefits provisions and rules to not only assure the proper amount of benefits are paid, but also make determinations regarding the order of payment when there are multiple sources of funds. We determine whether another party is primary for payment purposes and ensure that clients pay claims only when every other option has been exhausted. Pharmacy Claim Recovery In cases where another entity is responsible for payment of claims, pharmacy claims are often overlooked in the recovery process. The Phia Group proactively seeks to add pharmacy claims to the plan’s recoverable funds. We access pharmacy claims through the use of PBM partnerships and utilize pharmacy data to identify product liability cases. For additional information about The Phia Group’s Recovery Services, please contact: Andrew Milesky
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