Our solutions - Transforming Healthcare Program Integrity
Our integrated suite of solutions combines advanced AI with deep healthcare expertise to deliver comprehensive program integrity - from early detection of inappropriate utilization to precise payment reconciliation across complex value-based care models.
Sentinel
Early Warning System
Transform healthcare delivery through advanced monitoring and predictive analytics to prevent unnecessary services and detect fraud early.
- Advanced pattern detection across utilization, billing, provider networks, and emerging fraud schemes
- Smart workflows enabling rapid intervention and program optimization
- Proactive monitoring with risk scoring and clinical review integration
- End-to-end case management from alert to resolution with proven impact metrics
Accepted Data Sources:
- X12 837
- BCDA API
- CCLF
- ADT
Pulse
Medicare Performance Analytics
Enhance decision-making with comprehensive Medicare Fee-for-Service data and proprietary benchmarking capabilities.
- Detailed MSSP and ACO REACH performance metrics with drill-down capabilities
- Transparent benchmarking methodology showing exactly how you compare to peers
- Root cause analysis connecting utilization patterns to performance outcomes
- Forward-looking projections based on current trends and historical patterns
Scope
Payment Reconciliation Platform
Transform your program with comprehensive payment reconciliation that maximizes revenue and minimizes audit risks.
- Advanced reconciliation engine ingesting and processing data across multiple CMS systems
- Risk Adjustment reconciliation through RAPS, EDS, MARx, MAO-004, and other payment files
- Higher payment accuracy with fewer missing risk factors and faster reconciliation
- Stronger compliance through robust documentation and error detection
Our approach - Precision meets innovation
We combine cutting-edge AI technology with deep healthcare domain expertise to deliver solutions that protect program integrity while advancing quality care delivery.
- Proactive. Our AI-powered monitoring identifies potential issues before they impact your organization, enabling early intervention and prevention.
- Precise. We ensure accurate payment reconciliation across complex healthcare programs through sophisticated rule processing and validation.
- Comprehensive. From utilization monitoring to payment accuracy, our integrated approach provides end-to-end program integrity solutions.
- Compliant. We maintain rigorous compliance standards while adapting to evolving healthcare regulations and payment models.
- Collaborative. We work closely with our partners to understand their unique challenges and deliver tailored solutions that drive measurable results.
- Innovative. Our continuous investment in R&D ensures we stay ahead of emerging healthcare challenges and payment model complexities.
Partner with Falcon Health and join us in protecting the integrity of healthcare through intelligent monitoring.
Our offices
- Palo Alto, CA
Corporate HQ - Atlanta, GA
Technology Branch