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Predict FACS

The industry’s only post-adjudication, pre-payment system designed to identify complex, nuanced catastrophic claims issues in real time

Predict FACS:

AMS’ proprietary Financial and Clinical Surveillance (FACS) platform. It’s the Next evolution in high dollar claims oversight, replete with 350 Rules (encompassing 10K combinations). It’s laser-focused on complex issues that would warrant further scrutiny, easily identifying questionable claims with reason codes. FACS focuses on the affordability of care by combining AMS’ advanced analytics, technology and the intelligence of the Predict Suite.

How Predict FACS can help

TPAs, ASOs, and commercial payers adjudicate claims electronically in the majority. In fact, medical claims are electronically adjudicated 83.6% of the time, dental 92% of the time and pharmacy close to 100% of the time.

When it comes to auto-adjudication, Advanced Medical Strategies knows that one size does not fit all. You need smarter data analytics for smarter decision making.

Smarter Data Analytics for Smarter Decision Making
  • FACS’ aim is to focus on specific claims that require advanced detection analytics beyond current claim & FWA system capabilities
  • FACS is the ONLY system to contain AMS’ proprietary 350+ surveillance rules creating over 10k+ possible flag combinations
  • FACS utilizes machine learning, predictive modeling, and clinical anomaly detection
  • FACS gives near real-time response rates Pre-Pay/Post Adjudication with minimal IT requirements in a cloud-based solution—and no need for PHI
$173M ($14.41 PM/PM)

Is the juice really worth the squeeze regarding the top 1% of claims? You bet it is! Beta testing of 1 million members with claims totaling $23M in 2017 showed savings of $173M ($14.41 PM/PM) on claims that were already paid.

 

 

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