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| Consulting & Special Services |
Consulting & Special Services
As the laws affecting plan rights have changed, The Phia Group’s services have evolved to include specialized cost containment solutions and ensure claim cost efficiencies. As The Phia Group expands its service offerings, the mission to reduce the cost of clients’ health benefit plans through innovative technology, legal expertise, and personalized service remains unrivaled. Claim Processing Evaluation While time is of the essence, plans need to ensure claims are processed in accordance with the terms of the plan document. To compliment a clients’ in-house quality assurance process, The Phia Group will review all plan documents with a focus towards claims processing. If claims are pending or denied, we determine what additional materials are needed to properly process claims. Our ability to understand the differences in exclusion, coordination of benefits, and eligibility provisions are invaluable when making claim processing decisions. Stop Loss Claim Analysis The claims process can only run efficiently when every organization involved in the process works together. The Phia Group can facilitate this process to ensure a smooth transition by obtaining and supplying necessary facts, reports, documentation, and answers related to a particular claim. By providing this service, reinsurance issues are resolved with an effective, timely, and proper flow of information. Plan Administration Review and Defense Too often are Plan Administrators persecuted for processing claims in accordance with the terms of the applicable plan document or policy. Plan Administrators frequently find themselves defending their interpretation of the facts and application of the plan terms against appeals and complaints. The Phia Group can help, by advising on plan interpretation and defense of administrative decision-making. Dispute Resolution In the process of administering a benefit plan, clients will sometimes become involved in disputes with third parties regarding a range of issues. The Phia Group’s attorneys will assist clients in third party negotiations and secure conflict free relationships, as well as respond to provider complaints, handle balance billing issues, and manage third party conflicts. Whether it is by drafting correspondence for the administrator’s use, communicating with third parties on the administrator’s behalf, or even assisting in the defense of the administrator in Court, The Phia Group is here to help. For additional information about The Phia Group’s Consulting Services, please contact: Andrew Milesky
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