Health Plans
URAC-accredited technology-enabled solutions that cut costs and optimize efficiency.
Our evidence-based prior authorization, utilization management, and appeals reviews prevent fraud, waste, and abuse while strengthening member trust. FHAS is IRO and HUM accredited, delivering defensible decisions and sustained performance that benefit managers rely on.
Why Leading Payors Partner
with FHAS
Health Plans face increasing pressure to control costs, mitigate risk, and deliver timely, impartial decisions. FHAS combines accredited, independent clinical expertise with technology-enabled workflows and automation to streamline operations, improve accuracy, and ensure defensible, compliant outcomes.
- Reduce medical spend through accurate review
- Maintain compliance with URAC standards
- Offload complex appeals and prior authorizations
- Access deep clinical expertise across specialties
- Ensure fair resolutions under the No Surprises Act
Comprehensive Services for Health 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.
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.
Independent Dispute Resolution (IDR)
Navigate the No Surprises Act with Confidence
As the leading CMS-certified IDR Entity, we resolve disputes swiftly between providers and health plans. Our unbiased, cost-effective process ensures compliance, accuracy, and trusted outcomes—while delivering unparalleled client support.
Provider Outreach & Education
Targeted guidance to reduce errors and boost compliance
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.
Solving the Most Pressing Challenges for Payors
Challenge 1:
Rising Healthcare Costs
Healthcare costs continue to escalate, with unnecessary utilization and care driving up expenses. Traditional review processes often lack the clinical depth needed to identify all cost-saving opportunities.
FHAS Solution
Our URAC-accredited clinical review processes, led by licensed physicians and certified nurse coders, provide utilization management that identifies cost savings while maintaining quality care standards.
Challenge 2:
Lengthy Appeals Timelines
Protracted internal appeals and external reviews delay member care decisions, increase administrative costs, and risk regulatory noncompliance and member dissatisfaction.
FHAS Solution
FHAS accelerates case intake, applies standardized clinical criteria, and manages appeals through URAC-accredited workflows to shorten timelines and lower reversal risk.
Challenge 3:
Regulatory Compliance Complexity
Healthcare regulations are increasingly complex, with multiple overlapping requirements that create compliance risks. Organizations struggle to maintain current knowledge and implement proper processes.
FHAS Solution
Our dual URAC accreditation in IRO and HUM demonstrates our commitment to regulatory excellence. We maintain current knowledge of all requirements and implement proven processes that ensure compliance.
What Sets FHAS Apart
URAC Accreditations
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.
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.
Scalable Solutions
Flexible operations and teams scale seamlessly for commercial, self-insured, and TPA clients.
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