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falcon

Claims Intelligence

Sentinel

Your AI Co-Analyst for
Claims Intelligence.

Falcon Health · 2026

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falcon

The Problem

Fraud adapts faster
than your rules engine.

  • Data overload — finding suspicious patterns among millions of claims transactions requires analyst capacity most organizations simply don't have.
  • Slow investigations — manual investigations take days or weeks of analyst time. By then, the damage is done and the evidence trail is cold.
  • Evolving schemes — new billing patterns and exploitation tactics emerge faster than rule-based systems can catch them. Static rules miss dynamic fraud.
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falcon
Sentinel

Investigations in hours,
not weeks.

  • ✓ AI investigative agents — reason across utilization, billing patterns, and provider networks like a seasoned investigator, connecting signals human analysts would miss.
  • ✓ Three-pillar FWA research — internal claims analysis, digital footprint (web, social, legal records), and public databases (OIG, CMS enrollment, state licensing boards).
  • ✓ Cohort & HCC trajectory analysis — care-gap and risk signals across your population for population health monitoring and proactive outreach.
  • ✓ CMS-compliant investigation packages — AI-drafted overpayment recovery letters and referral packages with certified-mail tracking, ready to file.
Hours
vs. Weeks for Investigations
80–90%
Signal Coverage Across Data Pillars
3×
More Cases Reviewed Per Analyst
Accepted Data Sources
X12 837 · BCDA API · CCLF · ADT
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falcon
Sentinel

FWA investigation
in hours, not weeks.

Full provider background from public records, claims pattern analysis across your entire universe, and CMS-ready investigation reports — delivered in hours.

  • Complete digital footprint and public records analysis
  • Claims pattern analysis across your full universe
  • Live demo at your own data in 30 minutes
Sentinel — Claims Intelligence
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falcon

Stop fraud before
the damage is done.

Web
falconhealth.ai/solutions/sentinel
Email
sales@falconhealth.ai
Research
falconhealth.ai/blog
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