At FHAS, we bring nearly three decades of expertise as a URAC-accredited Independent Review Organization (IRO) and a trusted leader in medical claims adjudication, proudly serving both commercial insurance and government-sponsored programs. As one of the nation’s premier government contractors, we specialize in delivering fair, accurate, and timely resolutions for complex medical claims and appeals redeterminations for the Medicare Fee-for-Service and Medicare Advantage programs. With a proven track record of reviewing over 2.5 million Medicare claims, FHAS combines unparalleled expertise with the highest standards of quality and integrity. Whether you’re navigating commercial insurance appeals or the complexities of Medicare adjudication, FHAS is your trusted partner in achieving clarity, compliance, and confidence.
Medical Review Services
Why Choose FHAS for IRO Services?
When it comes to independent medical reviews, FHAS stands out for our expertise, dedication, and personalized approach. Here’s what sets us apart:
- Unmatched Expertise: Our reviews are overseen by a seasoned Medical Director and supported by a Quality Assurance team committed to excellence. With specialists across all medical fields, we deliver precise, evidence-based decisions you can rely on.
- Comprehensive Support: We provide peer-to-peer and specialty-matched reviews tailored to the unique needs of Medicare, ERISA, Medicaid Managed Care Organizations (MCOs), and Veterans Affairs (VA) programs, driving quality improvements and regulatory compliance.
- Client-Centric Service: At FHAS, you’re not just a case number. We offer personalized guidance, constant market insight, and a step-by-step process to ensure you’re informed and supported at every turn.
With decades of experience and URAC accreditation backing our processes, FHAS combines clinical rigor with a deep understanding of healthcare regulations to deliver results that matter.
Our IRO Specialty Services
FHAS offers a full suite of IRO services designed to address the diverse needs of payers, providers, and patients. Our offerings include:
- Third-Level External Reviews: Independent, unbiased evaluations for escalated claims, ensuring fair and defensible outcomes.
- Peer Reviews: Expert-led assessments by physicians matched to the specialty of the case, providing authoritative insights.
- Provider Outreach and Education: Collaborative efforts to improve provider practices and reduce future claims.
- Medical Coverage Decisions: Clear, compliant determinations on coverage eligibility.
- Bill Review Audits: Detailed audits to verify accuracy and appropriateness of medical billing.
- Pharmacy Claims Review: Specialized evaluations of pharmaceutical claims for cost-effectiveness and compliance.
- Malpractice Claims: Objective analysis to support resolution of liability disputes.
- Risk Management: Proactive strategies to minimize exposure and enhance decision-making.
- Prior Authorization and Pre-Certifications: Streamlined reviews to expedite approvals while ensuring adherence to mandated or adopted clinical review criteria.
- Corporate Integrity Agreement Audits: Rigorous oversight to meet regulatory and legal obligations.
- Health Plan Internal Appeals: Structured processes to review and resolve member or provider appeals within the health plan framework.
No matter the complexity of your case, FHAS has the expertise and resources to deliver actionable, high-quality solutions.
Our Medicare Specialty Services
FHAS offers a full spectrum of review and adjudication services tailored to meet the diverse needs of the Medicare ecosystem. Whether you’re seeking support for first-level appeals, complex reconsiderations, or prior authorizations, we deliver results with precision and speed. Our specialty review services include:
- First-Level Appeals/Redeterminations: Timely and accurate resolution of initial Medicare appeals.
- Second-Level Appeals/Reconsiderations: In-depth analysis for escalated cases requiring expert oversight.
- Prior Authorizations: Ensuring compliance and approval for necessary services and treatments.
- Medical Coverage Determinations: Assessing eligibility under Medicare coverage policies.
- Hospice Reviews: Specialized evaluations for end-of-life care claims.
- Concurrent Reviews: Real-time assessments to support ongoing patient care.
- Retrospective Payment Reviews: Thorough audits of past claims for accuracy and compliance.
- Recovery Audit Contractor (RAC) Reviews: Defense against overpayment recovery efforts with detailed analysis.
- Inpatient Hospital Claims: Expert adjudication of complex hospital stays and procedures.
- Skilled Nursing Facility Reviews: Focused evaluations for long-term care services.
- Outpatient Physician Services: Precise reviews of ambulatory care claims.
A Partner You Can Trust
FHAS understands the stakes involved in medical or legal reviews—financial, clinical, and emotional. That’s why we go beyond simply providing independent reviews; we act as a strategic partner, helping you navigate regulatory landscapes, improve operational efficiency, and achieve better outcomes. Our URAC accreditation is a testament to our commitment to quality, transparency, and independence, ensuring every review meets the highest industry standards.
How We Work
Our process is designed to be seamless and client-friendly:
- Case Submission: Submit your claim details securely through our streamlined intake process.
- Specialty Matching: After a conflict-of-interest check at the reviewer and organizational level, we assign your case to a reviewer with expertise in the relevant medical specialty.
- Thorough Review: Our team conducts a meticulous analysis, leveraging evidence-based guidelines and regulatory requirements.
- Clear Deliverables: Receive a detailed, actionable report tailored to your needs—on time, every time.
- Ongoing Support: We’re here to answer questions, provide insights, and guide you through next steps.
Ready to Get Started?
Let FHAS bring clarity to your medical claims process. Contact us today to learn how our IRO services can support your organization’s goals, improve quality, and ensure compliance. Together, we’ll turn complexity into confidence.
