For ACOs and provider organizations that bear financial risk
Protect your ACO’s budget from billing mistakes.
Falcon finds claims that may have been paid wrong, checks the health plan’s rules, and prepares its required form for your finance and operations team to review, where supported.
What changes
Human reviewedFind the wrong payment. Check the proof. Prepare the right form.
Why this matters for your ACO
A wrong charge can cut into your shared savings.
If your ACO is responsible for care costs under a risk-sharing agreement, a duplicate charge or incorrectly billed hospice claim can raise your recorded costs—even when you do not owe that money. Higher costs can mean lower margin and less shared savings.
A contestation is how you ask the health plan to fix that mistake and put the money back in your budget. The hard part is showing the proof and using the exact rules and form that plan requires.
Built for the details that matter
Less spreadsheet work. More cases ready to review.
Use each plan’s own reason codes
Each health plan has its own contract rules. Falcon checks claims against the reason codes that apply to that plan.
Fill out the real form correctly
Falcon uses the health plan’s required template and checks the IDs, dates, amounts, and reason codes before export.
Review before you send
For supported plans, Falcon prepares the claim and the form. Your team reviews the details and decides which cases are ready to file.
Timing is part of the opportunity
File early. Keep the case moving.
In one health plan’s process, a contestation may take three to six months to review. Timing varies by plan, but your team can avoid delays by sending a complete, correct request the first time.
Falcon shows the claims, patients affected, and dollars at stake in one place. For supported plans, it creates one combined file for categories that are ready, while keeping the rest visible for review.
Make recovery systematic
Stop losing money to complicated rules and paperwork.
See how Falcon Sentinel helps ACOs and risk-bearing provider organizations turn difficult rules and many forms into a clear, repeatable process.