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Defensible Medical Review for Federal Health Programs

Preventing fraud, waste, and abuse with faster outcomes, fewer backlogs, and less administrative strain.
URAC-accredited in IRO and HUM, FHAS delivers clinician-led, technology-enabled medical review, utilization management, and appeals support. Our audit-ready determinations combat fraud, waste, and abuse while meeting the rigorous demands of Medicare, Medicaid, and other federal programs.
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Why Federal Health Programs Choose FHAS

Federal program teams must tighten improper-payment risk, satisfy auditors, and make timely beneficiary decisions under heavy scrutiny. FHAS integrates with agency operations using URAC-accredited, clinician-led reviews that shorten decision timelines, strengthen defensibility, and reduce the burden of post-payment audits.

  • Cut improper payments and shorten recovery cycles 
  • Produce audit-ready determinations and documentation 
  • Scale appeals and prior-authorization workflows during surges 
  • Tap licensed physicians and certified nurse coders across specialties 
  • Meet federal procurement and compliance requirements (URAC IRO & HUM) 
Client FederalGovernment

Comprehensive Services for Federal Plans

Medical Review

Scalable, accredited reviews for compliance and efficiency

FHAS’ URAC-accredited HUM and IRO reviews, including utilization management, prior authorization, and other non-appeal reviews, ensure optimal healthcare delivery for commercial plans. Leverage expert ICD-10 coding and payment policy reviews of high-cost procedures, reducing improper payments, building efficiency, and achieving strong outcomes across all phases of care with evidence-based decisions.

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Appeals Management

Prompt, impartial handling of all appeal across levels of care

As a URAC-accredited IRO, FHAS provides appeals services, utilizing certified nurse coders and licensed physicians to manage 1st- and 2nd-level internal reviews, plus 3rd-level external appeals. For denied claims and prior authorizations in commercial plans, secure efficient resolutions that minimize disputes and uphold fairness.

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Provider Outreach & Education

Utilizing CMS’s Targeted Probe & Educate (TPE) program

Minimize claim errors through personalized education. Identify high-error providers and deliver 1:1 guidance on billing and best practices, improving accuracy, and reducing coding risks.

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Solving the Most Pressing Challenges for Federal Government Programs

Challenge 1:
Program Integrity & Rising Improper Payments

Improper payments from miscoding, inconsistent clinical decisions, and inappropriate utilization inflate costs and trigger audits. These issues undermine public trust and strain limited program resources.

FHAS Solution

Our clinician-led, URAC-accredited reviews apply consistent, evidence-based criteria to stop inappropriate payments before they become audit liabilities—while preserving access to necessary care. With nationwide physician reviewers and certified coders, FHAS delivers the scale federal programs need to reduce improper-payment rates.

Challenge 2:
Appeals Backlogs and Slow Determinations

Long appeal timelines delay benefits delivery, increase administrative load, and erode public trust. These backlogs create pressure on Federal agencies to accelerate decisions without sacrificing accuracy or compliance.

FHAS Solution

We speed intake and adjudication with standardized, compliance-first workflows and dedicated clinician teams, shortening turnaround times without sacrificing defensibility. Technology-enabled workflows and surge capacity ensure agencies keep pace with volume spikes.

Challenge 3:
Auditability & Regulatory Complexity

Overlapping federal rules and oversight demands create heavy documentation and process burdens that agencies struggle to meet. Without clear audit trails, determinations risk reversal, corrective actions, or funding clawbacks.

FHAS Solution

With dual URAC accreditation (IRO & HUM), procurement-aligned documentation standards, and secure, auditable processes, FHAS delivers the transparency agencies need to withstand review and oversight. Every determination is documented for defensibility, supporting compliance with CMS, OIG, and federal audit requirements.

What Sets FHAS Apart

Dual URAC Accreditation

URAC-accredited in both IRO and HUM, proving clinical and utilization review excellence.

Clinician-Led Review

Licensed physicians and certified nurse coders perform evidence-based, defensible medical determinations every time.

Expert Coding Analysis

Deep ICD-10 and payment-policy expertise that minimizes errors and prevents improper payments.

Scalable Solutions

Flexible operations and teams scale seamlessly for commercial, self-insured, and TPA clients.

Technology-Forward

AI-augmented analytics, workflow automation, and secure cloud platforms for faster, data-driven decisions.

Value-Based Fee Structure

Simple fixed-price model aligns incentives—consistent value, no billing surprises, and continuous performance optimization.

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