Since 1996, FHAS, a certified small business with full URAC, CMS-IDRE, and ISO 9001:2015 certification, is a leading provider of medical claims review and dispute resolution services. Clients include the Center for Medicare and Medicaid Services (CMS), Health Resources and Services Administration (HRSA), Indian Health Service (IHS), Veterans Affairs (VA), and health agencies in the following twenty-three (23) states/territories: Alaska, Arizona, Delaware, District of Columbia, Hawaii, Idaho, Indiana, Michigan, Minnesota, Montana, Nebraska, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania (multiple agencies), Puerto Rico, Tennessee, Utah, Vermont, and Washington.
FHAS has a 27-year history of furnishing the following services with 100% timeliness:
- 3rd Level External Reviews
- Pre-Claim Adjudications
- Provider Outreach and Education
- Independent Dispute Resolution (IDR)
- Medical Coverage Decisions Bill Review Audits
- Drug formulary Determinations
- Malpractice Claims & Risk Management
The FHAS Difference: Proven, Cost-Effective Results
- Adjudicated over 3 million Medical Claims Reviews with a timeliness rate of 100%
- Board-certified Physicians/Pharmacists encompassing all specialties of the ABMS
- Legal experts furnishing claims analysis and administrative law representation services
- Exemplary Past performance (CPARS) from state, federal, and health plan clients
- Over 100,000 No Surprises Act payment determinations issued
Core Competencies
- Extensive Legal and Medical Review Expertise: Industry leaders regarding inpatient and outpatient hospital and ancillary services, prescription medication, and durable medical equipment (DME), Medical Malpractice case review, and workers compensation medical necessity evaluations
- Audit Paid Claims and Medical Necessity Determinations: Auditing expertise includes conducting coding and billing data capture audits for multiple medical providers and facilities, medical documentation review for medical necessity and correct coding
- Prior Authorizations (PA): Adjudicates over 2000 PA requests monthly (expedited and standard)
- Provider Outreach and Education: FHAS uses Targeted Probe & Educate (TPE) to manage program integrity. FHAS performs 1:1 education for providers with a high likelihood of incorrect coding
Review Staff
- Certified Nurse Reviewer Coders: Vast experience adjudicating disputes regarding inpatient and outpatient hospital, skilled nursing facility, prescriptions, DME, and medical necessity. All Nurses possess CPC (Certified Professional Coder) certification
- Pharmacist: Experienced team of Pharmacists with expertise in health plans prescription claims involving step therapies, insufficient documentation, and formulary alternatives
- Physician Staff: Over 200 Board-certified physician and non-physician reviewers covering all specialties
- Legal Experts – Seasoned healthcare attorneys in administrative coverage determinations
