SERVICES

FHAS works with a diverse client base ranging from national health plans to state government agencies to pharmacy benefit managers to providers in private medical practice. We recognize that every client and every contract is unique, and we regularly work with new and returning clients to craft agreements specific to their business need.

 

 We view the following as simply a menu of services, and welcome the opportunity to discuss a customized business processing solution through which our experienced team of legal and medical professionals can best serve you. 

HEALTHCARE SERVICES

The FHAS team has in-depth knowledge of government health care programs and commercial health plans.

 

We are industry leaders regarding inpatient and outpatient hospital and ancillary services, prescription medication, durable medical equipment (DME), and Recovery Auditor Contractor (RAC) appeals.

 

Our healthcare services include:

  • Disability Claims Review

  • Health Plan Coverage Decisions

  • Independent Medical Reviews

  • Medical Necessity & Payment Accuracy Reviews

  • Medicare/Medicaid Claim Coverage Determinations

  • Peer Review

  • Pre-Admission Certification Reviews

  • Prescription Benefit Reviews

  • Prior Authorizations

  • Quality of Care Reviews/Malpractice Evaluations

  • Retrospective Claims Audits

  • URAC-Certified IRO for Internal & External Reviews, including professional services for Corporate Integrity Agreements (CIAs)

  • Utilization Review - Care Management

LEGAL SUPPORT SERVICES

​FHAS legal and medical experts utilize their knowledge and analytical skills to perform complex audits of contracts and transactional histories for our clients to determine whether contracts and transactions were properly executed or whether non-compliance and deficiencies exists. Our team can furnish administrative litigation support by reviewing documents, making determinations on whether files are confidential, and drafting basic templates and forms for your group.
 

  • Administrative Law Judge/Hearing Officer Services

  • Adverse Action Adjudications 

  • Document Workflow Organization Outsourcing

  • Litigation Support

  • Mediation and Arbitration

  • Tort Medical Review and Administrative Support Services

  • URAC-Certified IRO for Internal & External Reviews, including professional services for Corporate Integrity Agreements (CIAs)

GOVERNMENT BENEFIT ADMINISTRATION

FHAS has furnished government benefit administration and administrative services as either a prime contractor or subcontractor to:  

Federal

  • U.S. Department of Health and Human Services

    • Centers for Medicare & Medicaid Services

    • Health Resources and Services Administration

    • Indian Health Service

  • U.S. Department of Homeland Security

  • U.S. Department of Justice

  • U.S. Department of Veterans Affairs

State

  • Pennsylvania 

    • Department of Human Services

    • Office of General Counsel

    • Office of the Attorney General

  • Alaska

    • Department of Administration

    • Department of Commerce, Community, & Economic Development

  • Delaware

    • Department of Health & Social Services

  • Idaho

    • Department of Insurance

  • Indiana

    • Department of Insurance

  • Minnesota

    • Hennepin County

  • Montana

    • Commissioner of Securities & Insurance

  • Nebraska

    • Department of Insurance​

  • Nevada

    • Division of Insurance (External Review and Workers Compensation)

  • North Carolina

    • Department of Insurance

    • Department of Health & Human Services

  • North Dakota

    • Insurance Department

  • Oklahoma 

    • Community Care Managed Health Plans of Oklahoma

  • Oregon

    • Department of Consumer & Business Services and the Department of Financial Regulation

  • Tennessee

    • Department of Commerce & Insurance

  • Utah

    • Insurance Department, Life and Health Division

  • Washington

    • Office of Insurance Commissioner

 
 
 
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117 West Main Street

Plymouth, PA 18651

© 2020 by FHAS