Payment Intelligence and Clinical Integrity

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FACS (Financial And Clinical Surveillance) is a cloud-based, SaaS claims surveillance and workflow system that provides AI-driven insight into the costliest and most complex healthcare diagnoses and accompanying financial impact.

Automated clinical reviews and advanced financial analytics flag and report on complex claims. FACS is the industry’s premier high-cost claim technology.

Beyond The Here and Now

Dynamic dashboard reporting delivers strategic intelligence at a global level that informs and guides business initiatives.

  • Immediate Impact

    • Payment Integrity

      Payment Integrity

    • Fraud Prevention

    • Financial Benchmarks

    • Preauthorization Policy

    • Medical Management

  • Short-Term Impact

    • Site of Service Optimization

    • Payment Intelligence

  • Long-Term Impact

    • Payment Policy

    • Claims System Enhancements

    • Network Contracting

      Network Contracting & Optimization

    • Improved Medical Loss Ratio

Inside FACS

  • 15,000

    Proprietary Surveillance NanoScripts

  • 100,000+

    Questionable Claim Flag Combinations

  • 150,000

    Claims Processed Hourly

Executive Overview

Immediately receive valuable financial claims analysis and guide resources to address those responsible for the highest cost impact.

Strategic Intelligence

FACS' enterprise-wide reporting provides the insight and actionable data required for effective plan management and informed strategic business decisions.

Features & Benefits

  • Payment Integrity

    Payment Intelligence

    Quickly validate courses of treatment & identify egregious pricing

  • Dynamic Reporting

    Zero in on high-cost clams, networks, members and specialty drugs

  • Site of Service

    Prevent costly charges by directing members

  • Case Management

    Verify appropriateness of treatments, dosage regimens and specialty drug usage

Knowledge Is Power

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