Our solutions - One Engine. Four Ways to Use It.

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.

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.

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.

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.