State Certifications
FHAS provides URAC-accredited Independent Review Organization (IRO) and Health Utilization Management (HUM) medical review services for state and territory agencies managing Medicaid, CHIP, HHS programs, and other public assistance initiatives. Our clinician-led reviews deliver timely, defensible determinations that strengthen program integrity, reduce improper payments, and produce audit-ready outcomes while maintaining compliance with CMS and HHS requirements.
Our services also include impartial hearings and adjudication for denied coverage disputes, eligibility determinations, multi-level appeals management, and provider outreach using CMS’s Targeted Probe & Educate (TPE) program to reduce claim errors. FHAS ensures quality through our Medical Director, Project Manager, and Director of Quality, who review all determinations before issuance, delivering the transparency and defensibility state agencies need to withstand oversight and maintain public trust.
| State | Department | Certification / Contract |
|---|---|---|
| Alabama | Alabama Department of Public Health | Utilization Review Authorization |
| Alaska | Department of Commerce, Community, and Economic Development | Independent Review Organization |
| Arkansas | Arkansas Department of Health | Utilization Review Authorization |
| Arizona | Arizona Department of Administration, State Procurement Office | Independent Review Organization |
| Colorado | Colorado Department of Regulatory Agencies | Independent External Review Entity |
| Delaware | State of Delaware Department of Insurance | Independent Utilization Review Organization |
| District of Columbia | District of Columbia Housing Authority | Independent Review Hearing Officers |
| Georgia | Georgia Office of Commissioner of Insurance and Safety Fire | Independent Review Organization |
| Hawaii | Department of Commerce and Consumer Affairs | Independent Review Organization |
| Idaho | State of Idaho Department of Insurance | Independent Review Organization |
| Illinois | Illinois Department of Insurance | External Independent Review Organization & Utilization Review Authorization |
| Indiana | Indiana Department of Insurance | Independent Review Organization |
| Michigan | State of Michigan Procurement & Department of Insurance and Financial Services |
Independent Review Organization (IRO) for Auto Insurance No-Fault Utilization Review & Independent Review Organization for Patient's Right to Independent Review Act (PRIRA) |
| Montana | Office of Montana State Auditor & Commissioner of Securities and Insurance |
Independent Review Organization |
| Nebraska | State of Nebraska Department of Insurance | Independent Review Organization |
| Nevada | Nevada Division of Insurance | Utilization Review Authorization |
| New Hampshire | State of New Hampshire Insurance Department | External Review Organization |
| North Carolina | North Carolina Department of Insurance | Independent Review Organization |
| North Dakota | State of North Dakota Secretary of State | Independent Review Organization |
| Ohio | Ohio Department of Insurance | Independent Review Organization |
| Oklahoma | State of Oklahoma Insurance Department | Utilization Review Authorization (License to conduct Utilization Reviews) |
| Oregon | State of Oregon, acting through its Department of Consumer and Business Services, Department of Financial Regulation |
Independent Review Organization |
| Pennsylvania | Department of Health and Human Services | Independent Review Organization |
| Puerto Rico | Government of Puerto Rico Office of the Commissioner of Insurance | External Independent Review and Services (Agreement) |
| Tennessee | Tennessee Department of Commerce and Insurance | External Review Organization |
| Utah | Utah Insurance Department | Independent Review Organization |
| Vermont | Vermont Department of Financial Regulation | Independent Review Organization |
| Washington | Washington Office of the Insurance Commissioner | Independent Review Organization & Health Care Benefit Manager |
| Wyoming | The State of Wyoming Insurance Department | Independent Review Organization Certification |
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