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Predict FACS

AMS’ proprietary Financial And Clinical Surveillance platform

Your Next Best Move in Payment Integrity

TPAs, ASOs and commercial payers adjudicate claims electronically in the majority. In fact, medical claims are electronically adjudicated 83.6% of the time, dental 92% of the time and pharmacy close to 100% of the time.

PredictFACS integrates seamlessly with the Predict Suite, AMS’ modular directories that allow clients to predict, evaluate and manage high dollar healthcare claims.

Healthcare’s costliest issues; specialty pharmaceuticals, medical device technologies, and multi-million dollar claims, are rapidly expanding. While auto-adjudication does a broad spectrum of things well, it has limits - and these limits can be financially catastrophic. It may spot routine flags, but when it comes to complex catastrophic claims it’s algorithms falter. Legacy platforms no longer provide the solution you need. You need the next evolution of claims oversight to pay with precision. You need FACS.

Predict FACS

STOP Questionable Claims in their Tracks with FACS.

What is FACS

AMS’ proprietary FACS (Financial and Clinical Surveillance) cloud-based platform, is a revolutionary claims surveillance software built upon advanced AI. The first technology of its kind, FACS performs intelligent data examination on post-adjudicated, pre-payment claims to successfully identify and flag items that warrant additional review. FACS stops questionable claims in their tracks – before the check ever leaves your hand.

Who FACS serves

FACS serves those who utilize auto-adjudication for claims processing. FACS eliminates the payment integrity gap in this ever-evolving industry. Users are effectively protected against unwarranted spend - all without slowing down the claims process.

How is FACS different

FACS performs well beyond the current capability of any claim and FWA system on the market today. Utilizing the Predict Suite Software, FACS is designed to keep up with the continuous changes in specialty pharmaceuticals and complex clinical issues. FACS delivers the manpower of fifty large case managers with the enhanced brainpower of AI software to stay ahead of the complexities and pace of the industry. Plus, FACS is effortlessly user friendly, requiring zero IT resources as a cloud-based solution.

Smarter Data Analytics for Smarter Decision Making

FACS contains AMS’ proprietary 425+ surveillance rules creating over 10k+ possible flag combinations.

Enhanced brainpower and AI software keep you ahead of industry complexities via an in-depth analysis to bring the highest impact questionable claims immediately to attention.

Keep up with the continuous changes in specialty pharmaceuticals and complex clinical issues to deliver strategic business intelligence to executives surrounding major cost drivers throughout their books of business.

FACS empowers your large case management team, scaling their ability to new heights.

Cloud-based and user friendly, FACS requires minimal IT resources, allowing payers to quickly and easily integrate into any payment integrity system. FACS is an enhancement that makes your current process even better.

FACS performs lightyears ahead of any claim and FWA system on the market today.

Is the juice really worth the squeeze regarding the top 1% of claims?

You bet it is! A study of 1 million members with claims totaling 23M in 2017 showed
potential overpayments of $173M ($15 PM/PM) on claims that were already paid.