The Phia Group

Name

The Phia Group

Legal name

The Phia Group, LLC

Website

https://phiagroup.com

Company type

Private

Founded year

2000

Operating status

Operating

Headcount range

251–500 employees

Ownership category

akta.pro rank

Product category

Healthcare Cost Containment Services

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Agencies, Brokerages, and Other Insurance Related Activities (5242)

SIC

Hospital & Medical Service Plans (6324), Services-Legal Services (8111)

akta.pro primary industry

Self-Funded (ASO) Group Health Plans & Stop-Loss (FSAIAFAB)

akta.pro secondary industries

Stop-Loss & Reinsurance Administration (Captive/Level-Funded Support) (HLAEALAB), Large Group Health Insurance (Mid-Market & National Accounts) (FSAIAFAE)

Keywords

• Healthcare cost containment
• Claims repricing services
• Subrogation recovery services
• Reference-based pricing
• Health plan consulting

Headquarters

HQ city

Braintree

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Percentage of Savings: Fees charged as a percentage of healthcare costs saved for clients through cost containment services
2. Per Employee Per Month (PEPM): Subscription-style fees charged on a per-employee-per-month basis for ongoing services

Go-to-market motion2 records

Distribution channels3 records

Marketing channels6 records

Core offering

The Phia Group provides healthcare cost containment services for self-funded health benefit plans, including out-of-network claims repricing (Phia Unwrapped), subrogation and recovery (including mass tort), second-level appeals and fiduciary protection (PACE), reference-based pricing (Care Empowered Pricing), and B2B compliance and consulting (ICE), supported by proprietary technology such as the Phia Ignite repricing engine and the PATS administrative platform. Services are sold to third-party administrators, health plans, brokers, stop-loss carriers, and self-funded employers.

Product overview

The Phia Group offers a comprehensive ecosystem of healthcare cost containment services designed to work together or individually. The core portfolio includes Phia Unwrapped for out-of-network repricing, Subrogation & Recovery Services for third-party liability recovery, PACE for second-level appeals fiduciary protection, Care Empowered Pricing for reference-based pricing, and ICE for B2B compliance and business solutions. Supporting these are specialized modules including Claim Negotiation & Signoff, NSA Support, Balance Bill Resolution, Mass Tort Services, Phia Document Management, and Phia Ignite repricing engine technology. The company also offers SoPhia, an AI-powered regulatory consulting tool, and operates the PATS technology platform for claims and appeals management. Services are delivered to TPAs, health plans, brokers, stop-loss carriers, employers, and members.

Differentiator

Problem solved

Functional benefit

Brands

• Phia Group Consulting™: Plan language analysis and consulting service that analyzes health benefit plan documents, identifies areas of concern, and applies strategies to strengthen health benefit plan rights.
• Phia Unwrapped
• PACE®
• Care Empowered Pricing®
• ICE
• Phia Document Management® (PDM)
• SoPhia™
• Phia Ignite
• Phia CARES

Products and services

• Phia Unwrapped Comprehensive out-of-network repricing solution that replaces wrap network access and supports non-network payment methodologies. Implements reimbursement methodologies defined by TPAs and plan sponsors, calculating and defending those determinations through expert negotiation, balance bill support, and documentation.
• Subrogation & Recovery Services Industry-leading plan language and customized programs for identifying and recovering costs from third-party liability cases including motor vehicle accidents, workers' compensation, and mass tort claims, using proprietary logic and case detection technology to uncover recovery opportunities.
• PACE (Plan Appointed Claim Evaluator) Second-level appeals review service that provides objective oversight, shares fiduciary liability with a third party, and offers indemnification against damages arising from fiduciary breach. Uses PATS proprietary technology to ensure thorough decision-making with clinical review and access to URAC-accredited IROs.
• Care Empowered Pricing Reference-based pricing (RBP) solution that empowers TPAs with technology-enabled provider selection and access support. Features the Ignite repricing engine for calculating defensible payments based on Medicare benchmarks, usual and customary rates, or plan-defined methodologies.
• ICE (Independent Consulting & Evaluation) B2B compliance and business solutions partner providing fixed-rate access to a multi-million-dollar compliance and business solutions team. Includes plan language review, claims and appeals consultation, regulatory compliance support, stop-loss coordination, and NQTL comparative analysis for MHPAEA compliance.
• Phia Group Consulting Service analyzing health benefit plan documents, identifying areas of concern, making recommendations, and applying strategies to strengthen health benefit plan rights, combining technology, forward-thinking creativity, and a client-centric customized approach for plan drafting and revision.
• Mass Tort Services Comprehensive mass tort case analysis and management partnering with nationally recognized mass tort law firms. Includes proprietary software leveraging algorithms that analyze claims and demographics to identify mass tort opportunities involving drugs, devices, toxins, recalls, and other hazardous exposures.

Quantifiable outcome

• Significant healthcare cost savings for self-funded plans through repricing, appeals, and AI-driven optimization

Named customers3 records

Segments5 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

AI capability2 records

Feature3 records

Partnerships

One partnership is on record.

• Healthcare Recovery Solutions, LLCminorStrategic or Co-development PartnerHealthcare Recovery Solutions, LLC is a strategic partner supporting mass tort-related healthcare cost recovery initiatives. The partnership enables coordinated efforts in recovering costs associated with mass tort cases affecting healthcare claims and benefits administration.

Scale indicators1 record

Recent moves6 records

Direct peers

• Collective Health: Collective Health operates a technology-led self-funded employer health benefits platform with integrated cost management, navigation, and analytics — directly comparable to Phia's self-funded plan focus, although Collective Health owns more of the plan administration stack while Phia operates as a value-added cost-containment partner.
• Zelis: Zelis is a healthcare cost management platform offering claims cost containment, network solutions, payment integrity, and analytics to payers, TPAs, and employers — directly overlapping Phia's repricing, RBP, and analytics offerings for the same self-funded plan stakeholder set.
• Lyric: Lyric (formerly ClaimsXten) delivers AI-driven payment integrity, claims editing, and cost containment for health plans and TPAs, closely paralleling Phia's claims repricing and optimization capabilities via technology-led workflows.
• MultiPlan: MultiPlan is a leading provider of healthcare cost containment solutions including PPO networks, repricing, and payment integrity services, serving TPAs, insurers, and self-funded plans — directly comparable to Phia's out-of-network repricing and network replacement (Unwrapped) offerings.
• Cotiviti: Cotiviti provides payment integrity and healthcare cost containment through claims editing, subrogation, and clinical validation services for payers and TPAs — directly comparable to Phia's appeals, subrogation, and repricing stack serving similar payer and plan administrator customers.
• Performant Financial Corporation: Performant provides payment integrity, subrogation, and recovery services to healthcare payers, making it a direct competitor to Phia's subrogation, recovery, and cost-containment services for health plans.
• Gainwell Technologies (formerly HMS Holdings): Gainwell (which absorbed HMS Holdings' payment integrity and coordination-of-benefits business) delivers cost containment, third-party liability, and recovery services to Medicaid and commercial payers — closely comparable to Phia's subrogation and recovery service line.

Emerging players

• Springbuk: Springbuk is a health benefits analytics and intelligence platform for self-funded employers, brokers, and TPAs — an emerging player whose employer-focused analytics overlaps with Phia's cost-optimization and reporting offerings, although it is more analytics-led than claims-repricing focused.

Broad incumbents

• Optum (UnitedHealth Group): Optum, through Change Healthcare and other units, offers a broad portfolio of healthcare cost management, payment integrity, analytics, and consulting services to payers, providers, and employers — a scaled incumbent whose capabilities overlap Phia's but extend across the full healthcare value chain rather than the self-funded plan niche.
• Conduent: Conduent is a large business process services provider with a healthcare division offering claims processing, utilization management, and benefits administration to payers and plans — a broad incumbent whose healthcare BPO operations overlap portions of Phia's TPA-adjacent services.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks5 records

Key highlights7 records

Customer concentration

• Xx.com/thephiagroup
• YouTubeyoutube.com/@ThePhiaGroupLLC
• Facebookfacebook.com/the-phia-group-llc-167450315780
• LinkedInlinkedin.com/company/the-phia-group-llc

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Subsidiaries1 record

Funding overview

Funding rounds2 records

Investors5 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about The Phia Group