Your Expert SIU/PI Services Partner for Healthcare FWAE
Today’s insurance companies not only need to protect their network against fraud, waste, abuse and error, they need to minimize the impact on their Medical Loss Ratio (MLR) and prevent provider abrasion.
Unmatched FWAE Consulting for Maximum Impact
- Industry-leading FWAE consulting to detect, verify, and prevent fraudulent billing
- Expert support in identifying inappropriately billed claims
- Case development and medical record review services
- Actionable insights to drive recoveries and savings, prevent loss and reinforce compliance
Seamless SIU/PI Support with Proven Results
- Full or partial outsourcing of SIU/PI operations
- Operate as an extension of your internal team using the HCFSPlatform
- Maintain complete audit trails and investigative continuity
- Deliver data-driven results that enhance fraud detection and prevention
Build Your Advantage
HCFSPlatform + existing processes
Adding modules AIShield, RxShield and SharedAnalytics incrementally increases ROI
HCFSPlatform + HCFSServices
We can validate an ROI of up to $20 for every $1 spent.
Our Subject Matter Experts
Certified to Deliver Results
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- Accredited Health Care Fraud Investigators (AHFI)
- Certified Professional Coders
| • CPC | • COC | • CCM |
| • CPC-P | • CRC | • CCM-P |
| • CPMA | • CPC-I | • CDC |
| • CDEO | • CEMC | |
| • CPCO | • CFPC |
Where Expertise Meets Education
Our team also routinely provide certification and educational training nationally for various organizations, including:
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- National Health Care Anti-Fraud Association (NHCAA)
- Association for Community Affiliated Plans (ACAP)
- American Academy of Professional Coders Local Chapters (AAPC)
- Health Plan Alliance (HPA)
- Healthcare Payment Integrity Congress (HPRI)
- and more