State Government
Timely decisions, fair hearings, and reduced administrative burdens for state and territory agencies.
URAC-accredited in IRO and HUM, FHAS delivers clinician-led, technology-enabled eligibility reviews and appeals, hearings and adjudication support, and assistance program management, producing audit-ready outcomes built to meet the demands of Medicaid, CHIP, HHS programs, and other state and territory initiatives.
Why State Programs Partner
with FHAS
State and territory agencies must manage tight budgets, ensure compliance with federal and state regulations, and deliver equitable access to care under public scrutiny. FHAS integrates with agency operations using URAC-accredited, clinician-led reviews that accelerate coverage decisions, enhance fairness in hearings, and ease the strain of assistance program administration.
- Strengthen program integrity and reduce improper payments
- Deliver audit-ready determinations and documentation
- Scale eligibility reviews, hearings, and adjudication during volume surges
- Access licensed physicians and certified nurse coders across specialties
- Meet state procurement, HHS, and federal compliance requirements (URAC IRO & HUM)
Comprehensive Services for Health Plans
Hearings and Adjudication Services
Prompt, impartial handling of appeals and administrative hearings
As a URAC-accredited IRO, FHAS provides hearings and adjudication services, utilizing certified nurse coders and licensed physicians to manage internal reviews, fair hearings, and external adjudications. For denied coverage and assistance program disputes in state and territory initiatives, secure efficient resolutions that minimize conflicts and uphold equity.
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.
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.
Solving the Most Pressing Challenges for State Agencies
Challenge 1:
Improper Payments in Assistance Programs
Improper payments from miscoding, inconsistent coverage decisions, and inappropriate utilization in Medicaid, CHIP, and HHS programs inflate costs and trigger audits. These issues undermine public trust and strain limited state resources.
FHAS Solution
Our clinician-led, URAC-accredited reviews apply consistent, evidence-based criteria to prevent inappropriate payments before they become audit liabilities. With nationwide physician reviewers and certified coders, FHAS delivers the scale state and territory agencies need to reduce improper-payment rates across assistance programs.
Challenge 2:
High Volumes & Surge Demands
Prolonged hearing timelines delay beneficiary access, increase administrative load, and erode public trust. These backlogs create pressure on agencies to accelerate adjudications without sacrificing accuracy or compliance.
FHAS Solution
We improve 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 in appeals and fair hearings.
Challenge 3:
Regulatory Complexity in HHS Programs
Overlapping state and federal rules, including HHS mandates, 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, HHS, and state 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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