Company
Trusted national leader in medical claims review, dispute resolution, legal adjudication, and business process outsourcing
FHAS, a URAC-accredited Independent Review Organization (IRO) and Health Utilization Management company, is a trusted national leader in medical claims review, dispute resolution, legal adjudication, and business process outsourcing. As the industry’s premier Independent Dispute Resolution Entity (IDRE) and a leading Medicare and claims review partner, FHAS leverages nearly 30 years of expertise to deliver fair, accurate, and timely solutions for healthcare providers, payors, and federal and state government programs.
Our History
Since 1996, FHAS has been a certified small business with URAC IRO and HUM accreditations, CMS-IDRE designation, and ISO 9001:2015 certification. A recognized national leader in medical claims review and dispute resolution, FHAS serves commercial health plans, TPAs, PBMs, and self-insured employers, as well as federal clients such as the Center for Medicare and Medicaid Services (CMS), Health Resources and Services Administration (HRSA), Indian Health Service (IHS), and the Department of Veterans Affairs (VA), along with health agencies in more than 30 states and territories.
FHAS has 30 years of experience delivering:
- 1st, 2nd-, and 3rd-level internal and external reviews
- Pre-claim adjudications
- Provider outreach and education
- Independent Dispute Resolution (IDR)
- Medical coverage decisions and bill review audits
- Drug formulary determinations
- Malpractice claims and risk management
Proven, Cost-Effective Results
- Adjudicated millions of medical claims reviews with a 100% on-time completion rate
- Board-certified physicians and pharmacists covering all ABMS specialties
- Legal experts providing claims analysis and administrative law representation services
- Recognized for exemplary past performance (CPARS) from State, Federal, and commercial clients
Core Competencies
Extensive Legal and Medical Review Expertise
Industry leader in reviewing inpatient and outpatient hospital and ancillary services, prescription medications, 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 comprehensive coding and billing audits across multiple medical providers and facilities, and medical documentation reviews for medical necessity and accurate coding
Prior Authorizations & Utilization Management
URAC-accredited in both IRO and HUM, FHAS provides pre-service prior authorization, utilization management, and other pre-claim reviews for Federal, State, and commercial insurance plans
Provider Outreach and Education
FHAS leverages Targeted Probe & Educate (TPE) to strengthen program integrity, providing one-on-one education for providers identified as having a higher likelihood of incorrect coding
Review Staff
Physician Staff
Team of over 200 Board-certified physician and non-physician reviewers spanning all medical specialties
Certified Nurse Reviewer Coders
Extensive experience adjudicating disputes related to inpatient and outpatient hospital, services, skilled nursing facilities, prescriptions, durable medical equipment (DME), and medical necessity. All Nurses hold Certified Professional Coder (CPC) certification
Pharmacist
Experienced team of Pharmacists specializing in health plan prescription claims including step therapies, insufficient documentation, and formulary alternatives
Legal Experts
Seasoned healthcare attorneys specializing in administrative coverage determinations