Independent validation gives health plans and government programs greater confidence when delegating utilization management.
Federal Hearings and Appeals Services (FHAS) has earned three-year NCQA Utilization Management Accreditation, reinforcing our position as a trusted partner for health plans and government programs seeking fair, timely, and clinically sound healthcare determinations.
NCQA Utilization Management Accreditation independently validates the processes supporting FHAS’s prior authorization, medical-necessity review, and first-level appeal services. The evaluation examined FHAS’s clinical governance, reviewer qualifications, quality-improvement practices, member protections, and operational controls.
For organizations considering a utilization-management partner, the accreditation provides added confidence that FHAS has the people, processes and infrastructure to perform complex clinical reviews consistently and at scale.
FHAS Always Keeps Qualified Humans in the Loop
With over five (5) million reviews completed, FHAS brings 30 years of experience in government and commercial healthcare review. At the center of our model is a nationwide network of physicians and other qualified clinical professionals whose judgment is supported—but never replaced—by technology.
“FHAS uses technology to strengthen human review, not replace it,” said James Bobeck, Esq., Chief Executive Officer of FHAS. “Our intelligent workflows help organize medical records, identify relevant clinical evidence and streamline case preparation. That allows our physicians, nurses, pharmacists, coders, and legal reviewers to focus on what matters most: applying their expertise to reach accurate, consistent, and medically sound determinations.”
A standard that is earned, not assumed
Achieving NCQA Utilization Management Accreditation demonstrates that FHAS has the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards,” said Margaret E. O’Kane, President, NCQA.
A trusted delegated partner for utilization management
Health plans, managed care organizations, third-party administrators, and government programs face increasing expectations for transparency, timeliness, and consistency in utilization management. Choosing the right review partner is therefore more than an operational decision—it is a matter of regulatory confidence, member trust, and program performance.
FHAS provides scalable utilization-management solutions supported by qualified clinical reviewers, disciplined quality controls, and technology-enabled workflows. Whether an organization needs additional clinical capacity, specialized expertise, or a comprehensive delegated-review solution, FHAS can develop a model aligned with that organization’s clinical, operational, and regulatory requirements.
Ready to learn more? Visit www.fhas.com or meet with our team.
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The information contained in this content piece is for general informational purposes only. While we strive to ensure the accuracy and completeness of the information presented, we make no representations or warranties of any kind, express or implied, about the accuracy, reliability, suitability, or availability with respect to the content or the information, products, services, or related graphics contained in the content piece for any purpose. Any reliance you place on such information is therefore strictly at your own risk. The content of this page is subject to change without notice. The information provided in this document does not constitute legal or other professional advice, and is non-binding upon FHAS and any federal government agencies.
