The Most Effective Payment Integrity, Cost Containment & FWAE End-to-End Solution

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PI & SIU teams can investigate pre-payment & post-payment FWAE claims quickly & with confidence.

Industry-leading healthcare insurers trust the HCFSPlatform® to power Payment Integrity and Cost Containment, preventing millions in losses annually. With AI-driven anomaly detection, a proprietary data fusion library, and a robust rules engine, it delivers an end-to-end solution for auditing, SVRS, medical record retrieval, and more—maximizing savings and efficiency.

Maximize your ROI

Claims

%

Reduction in False Positives

in Savings for Just 1 Client

Why Organizations Choose HCFS

Whether you are struggling with spreadsheets or antiquated software, HCFS offers and end-to-end solution that helps your payment integrity, cost containment, and SIU departments reduce false positives and improve claim payment accuracy — saving significant time and money.

Actionable Insights

Leading FWAE Subject Matter Experts

Superior Customer Service

Industry-leading healthcare insurance companies rely on the HCFSPlatform®

This comprehensive, AI-driven solution integrates a proprietary data fusion library, an extensive rules knowledgebase, and advanced anomaly detection to effectively combat fraud, waste, abuse, and errors. By leveraging the HCFSPlatform®, insurers achieve millions in annual savings, recoveries, and loss prevention, reinforcing its critical role in cost containment efforts.

Data fusion library aggregates internal and external data sources like NPI, open payment, SOS data, state sanction lists, and virtual offices.

Data fusion library aggregates internal and external data sources like NPI, SOS data, state sanction lists, and virtual offices.

Proprietary shared analytics database sources data from 70MM+ payers nationwide.

Robust and expanding 2,000+ industry rules knowledge base.

AI driven anomaly detection and alerts users to high-risk providers, claims and members.

Drill down to claim-line level detail.

Fully integrated modules including pre- and post-payment data

What Our Clients Say:

“Since using HCFS, weʼve seen an increase in our ROI thanks to greater identification of leads and an easy-to-use solution to track leads and cases.”

“HCFS has helped us in reducing the volume of false positives and giving us actionable leads to prevent fraud, waste, and abuse.”

“With HCFS we have improved ROI, better regulatory compliance, and accuracy of reporting to the states as result of data and activity tracking.”

“HCFS has provided greater team efficiency to process leads and cases, tremendous organization, very informative analytics and provider risk score to help prioritize alert...

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