Payment Integrity
Payment Intelligence and Clinical Integrity
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.
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Immediate Impact
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Fraud Prevention
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Financial Benchmarks
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Preauthorization Policy
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Medical Management
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Short-Term Impact
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Site of Service Optimization
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Payment Intelligence
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Long-Term Impact
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Payment Policy
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Claims System Enhancements
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Network Contracting & Optimization
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Improved Medical Loss Ratio
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Inside FACS
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15,000
Proprietary Surveillance NanoScripts
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100,000+
Questionable Claim Flag Combinations
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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
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Payment Intelligence
Quickly validate courses of treatment & identify egregious pricing
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Dynamic Reporting
Zero in on high-cost clams, networks, members and specialty drugs
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Site of Service
Prevent costly charges by directing members
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Case Management
Verify appropriateness of treatments, dosage regimens and specialty drug usage