Claim appeals can be burdensome to handle and may open plan sponsors up to financial risk. That’s why Meritain Health® is happy to offer the Plan Appointed Claim Evaluator (PACE) Program, through the Phia Group. This optional benefit is designed to help plan sponsors face these risks head on.
At Meritain Health, we’re always looking for ways to make sure our clients have what they need to offer the best services and products to members.
The PACE Program offers affordable fiduciary support for internal claim appeals. So, instead of the hassle and the fiduciary burden of appealing a claim externally through a court of law or using an independent review organization, clients have access to PACE. This program offers protection against fiduciary breaches and ensures the proper handling of appeals.
PACE is also proactive and precise— experts review plan documents right from the outset of coverage and carefully vet plan language to avoid confusion and ensure proper handling.
How does it work?
After carefully reviewing the details of coverage and its application to claim adjudication, Phia Group promises to review the internal appeals and appropriate regulations. As the final-level appeal fiduciary in plan documents, Phia Group helps our clients to:
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- Outsource difficult appeals and shift liability to a trusted source, alleviating concerns of handling complicated appeals.
- Prevent reimbursement delays or denials by identifying reimbursement issues and/or coverage gaps before they occur.
- Minimize stop-loss on higher-risk claims.
- Keep track of changing legislative mandates and protect against possible lawsuits.
Most importantly, PACE offers peace of mind—something every client can use in today’s hectic world.
To learn more about this valuable program, contact your Meritain Health representative today!
