FHAS provides expertise in conducting URAC-certified Independent Review Organization (IRO) medical reviews and claim adjudications across all medical specialties. We offer peer-to-peer and specialty-to-specialty match reviews that can include any of the American Board of Medical Specialties (ABMS) specialties, supporting organizations like Medicare Advantage (MA), ERISA and large employer-sponsored plans, Medicaid Managed Care organizations (MCOs), and Veterans Health Administration (VHA) in their quality improvement efforts.
Our 27+ years of independent medical review expertise includes the following: 3rd Level External Reviews, Peer Review, Provider Outreach and Education, Medical Coverage Decisions, Bill Review Audits, Pharmacy Claims Review, Malpractice Claims, Risk Management, Prior Authorizations and pre-certifications, and Corporate Integrity Agreement (CIA) Audits.
FHAS provides the highest level of quality medical decisions. FHAS employs a Quality Assurance (QA) Department comprised of our Medical Director, Project Manager, and Director of Quality, who are tasked with reviewing all medical reviews prior to issuance to ensure quality objectives are met.
Our services cover various issues, including prescription drugs, medical necessity, surgery, experimental treatments, out-of-network issues, and correct coding. We work with federal departments to adjudicate healthcare reimbursement disputes between healthcare providers and health carriers/plans, utilizing mandatory arbitration proceedings to finalize payment amounts for healthcare services.
