To help self-funded health plans avoid the risk and burden that arises when an adverse benefit determination is appealed, Diversified Group authorizes Phia Group to serve as a Plan Appointed Claim Evaluator (PACE).
- A PACE assures that all claims have been correctly paid pursuant to the Plan Document.
- A PACE reviews the employer’s decisions before any other external review is conducted.
- The risk of an arbitrary decision and resulting fiduciary breach is eliminated.
Most important, if a PACE determination is appealed, the Phia Group will defend its findings. If the PACE is found to have breached its fiduciary duty, it will cover any associated damages, short of payment of the actual claim. PACE – one more way Diversified Group helps self-funded plans manage the risks and future costs of health care.