Our products - Manage care, payments, provider networks, and MA data together.
Find care gaps, investigate improper payments, evaluate provider partners, and reconcile Medicare Advantage payments. Helm, Sentinel, Pulse, and Scope connect your data and reports with public datasets and benchmarks, so your team can follow a question across workflows.
Investigate improper payments with Sentinel
Falcon for Claims Intelligence
Falcon for FWA, overpayment, and contestation analysis — compliance on how claims should get paid. Expert research and interpretation of Medicare coverage policies, comprehensive background and digital footprint analysis of providers under investigation, and deep-dive claims pattern analysis to identify suspicious billing practices with complete claims universe visibility.
- Intelligent investigation that understands Medicare policies and cross-references multiple data sources
- From weeks to hours: comprehensive investigation reports delivered faster than ever
- Proactive monitoring that detects anomalies and alerts you to patterns that need attention
- Professional reports ready for leadership review and action
Accepted Data Sources:
- X12 837
- BCDA API
- CCLF
- ADT
Evaluate provider partners with Pulse
Falcon for Network Analytics
Understand member attribution, track utilization patterns, benchmark performance, and identify the best providers for your organization. Turn complex Medicare data into clear, actionable insights that help you optimize your provider network and value-based care programs.
- Detailed MSSP and ACO REACH performance metrics with drill-down capabilities
- Transparent benchmarking showing exactly how you compare to peers
- Root cause analysis connecting utilization patterns to performance outcomes
- Professional reports that stakeholders and leadership can immediately understand
Reconcile MA data and payments with Scope
Falcon for Risk Adjustment
The risk adjustment payment integrity command center for Medicare Advantage (MA), MA Prescription Drug (MAPD), Standalone PDPs, and PACE programs. Navigate complex CMS data flows, reconcile risk adjustment payments, ensure payment accuracy, and protect against audits. As a certified CMS encounter data submission vendor, Falcon manages the full pipeline — from 837 claims and paper-to-clearinghouse conversion through encounter data submission — and automates the heavy lift of processing all 70+ CMS files, giving you complete visibility into your risk adjustment revenue without the manual spreadsheet fatigue.
- 100% file coverage across all 70+ CMS data files including MAO-002, MAO-004, MMR, and MARx
- Real-time reconciliation of files, membership, and payments with AI-powered insights
- $80-$160 PMPM revenue recovery through complete data visibility
- Audit-ready documentation ensuring Fair, Accurate, Complete, and Timely payments
Find care gaps and track performance with Helm
Falcon for ACO Care Management & Operations
Falcon for ACO member alignment, quality measure calculation, and provider relationship management. Implements the complex logic behind member attribution and quality scoring, and connects the dots between esoteric CMS reports — Monthly Expenditure Reports, Benchmark Reports, Quarterly Alignment Reports — and your underlying data. No more reading them report by report: Helm connects them all and surfaces the bigger story and the opportunities hiding in between.
- Member alignment, done right: the complex logic behind attribution, handled for you
- Quality measure calculation tied directly back to the underlying claims and clinical data
- One connected story across Monthly Expenditure, Benchmark, and Quarterly Alignment Reports
- Provider relationship management and root-cause analysis to explain exactly why performance moved
Why Falcon - Ask a healthcare question. See the evidence behind the answer.
Falcon works with Medicare policies, CMS data formats, and the methods your team uses. Inspect the sources and analysis behind an answer, then turn useful work into reports and repeatable workflows.
From Weeks to Hours
What used to take your team days or weeks of manual analysis now takes hours. Falcon handles the heavy lifting so your experts can focus on decisions.
Built for Healthcare
Generic AI tools don't understand Medicare policies, CMS data formats, or healthcare operations. Falcon does. We've encoded deep healthcare expertise into every analysis.
Share findings your team can act on
Stop spending hours formatting spreadsheets for executives. Falcon delivers beautiful, presentation-ready analytics that stakeholders can immediately understand and act on.
Catch changes before the next review
Don't wait for problems to become crises. Our AI continuously monitors your data, detects anomalies early, and alerts you to patterns that need attention.
Works Alongside You
Falcon isn't here to replace your team. It's here to amplify them. Falcon handles the research and analysis so your experts can focus on strategy and decisions.
Keep the work your team has already done
Save trusted queries, methods, and instructions as reusable Skills. Your next investigation starts with your team's knowledge instead of a blank page.
Bring the question your team needs to answer.
See how Falcon connects your care, payments, and performance work with the evidence your team needs to act.
Our offices
- Palo Alto, CA
Corporate HQ - Atlanta, GA
Technology Branch