VBA Announces Partnership with The Phia Group for No Surprises Act Claims Repricing and Appeals and Grievances Processing

GERMANTOWN, WI – June 14, 2023 VBA, a leading technology company for healthcare payers, announced a partnership with The Phia Group to integrate the Ignite claims repricing engine and PROS case tracking solution with the VBASoftware core administrative processing system and the VBAGateway portal solution.

As healthcare payers continue to deal with the challenges of implementing the Cost Transparency Rule and the No Surprises Act, they are looking for technology solutions that can increase efficiency and help them keep track of multiple levels of complex information needed to accurately process claims.

“Cost transparency regulations have put healthcare claims costs under a microscope,” said Mike Clayton, President and CEO of VBA. “Healthcare payers need tools to help them determine reasonable and defensible pricing for healthcare claims based on benchmarking and quality data.”

By integrating the Ignite claims repricing tool with VBASoftware, healthcare payers have access to real-time repricing of claims that is based on benchmark data for similar services performed by local providers and adjusted for severity. Payers can also utilize the cost and quality data to advise consumers about which providers offer the most value for a specific service or procedure.

The Cost Transparency Rule and the No Surprises Act have also opened up new avenues for negotiation and dispute resolution related to claims pricing, creating a large influx of appeals and grievances.

“Healthcare consumers and providers have access to more detailed cost information than ever before, and they are engaging in the discussion about what services cost and what is reasonable to pay,” explained Adam Russo, Co-Founder and Chief Executive Officer of The Phia Group.

Processing appeals and grievances can be time-consuming because information is located in multiple systems and is not always readily available. VBA’s partnership with The Phia Group provides an integrated and efficient way for payers to manage this increased volume without adding more work for their existing staff.

By integrating VBASoftware with the PROS case tracking solution, all of the necessary information will be located in one place, which will improve accuracy of decisions and reduce the time it takes to process appeals and grievances. As an added benefit, the PROS system will automatically share case activity and information back to VBASoftware.

As technology leaders for healthcare payers, VBA and The Phia Group are driving change in the industry with solutions that make the healthcare experience better for everyone. To learn more, contact us at [email protected] or visit our website at vbasoftware.com.



About VBA

VBA is a leading-edge healthcare technology company providing an integrated suite of solutions for healthcare payers. Our secure, scalable solutions provide critical information in a timely manner, positively impacting member outcomes while reducing administrative costs. The healthcare system is complex, but with the functionality and interconnectivity of our solutions, VBA makes it simpler and more efficient for everyone. Learn more at vbasoftware.com.


About The Phia Group

The Phia Group, LLC, headquartered in Canton, Massachusetts, and with offices in Hartford, Boise, and Louisville, is an experienced provider of health care cost containment techniques offering comprehensive claims recovery, plan document and consulting services designed to control health care costs and protect plan assets. By providing industry leading consultation, plan drafting, subrogation and other cost containment solutions, The Phia Group is truly empowering plans. Learn more at phiagroup.com.