FHAS

What FHAS does

FHAS (Federal Hearings and Appeals Services, LLC) is a privately held, URAC-accredited healthcare dispute resolution and medical review firm founded in 1996 and headquartered in Wilkes Barre, Pennsylvania. The company delivers five core services — Medical Review, Appeals Management, Independent Dispute Resolution (IDR), Hearings and Adjudication Services, and Provider Outreach & Education — to four vertical segments: commercial health plans, federal agencies (including Medicare and veterans' health programs), state and territorial Medicaid/CHIP agencies, and government contractors. Its IDR practice operates under the federal No Surprises Act framework as a CMS-certified IDR entity.

The firm runs its services on scalable, AI/augmented-enabled cloud-based platforms with workflow automation and advanced analytics, layering structured human clinical and legal expertise (physicians, nurses, coders, administrative law judges) over the automated adjudication pipelines. FHAS holds dual URAC accreditations in Independent Review Organization (IRO) and Health Utilization Management (HUM), was the first organization to receive the URAC IDR Designation in November 2025, holds ISO 9001 program-level certification, and secured a GSA Multiple Award Schedule Contract in October 2025 to access federal procurement channels directly.

FHAS earns revenue through a hybrid model: transaction-based per-dispute IDR fees (CMS-regulated, ranging from $540 to $1,340 depending on claim type and batch size for 2026 disputes) and professional-services fees for medical review, utilization management, appeals, and administrative hearings. The go-to-market is consultative, direct enterprise field sales supported by a content-led marketing buildout (industry blog, FHAS Insider newsletter, expert video series, IDR Knowledge Base). At 51-100 employees, the company processed over 100,000 IDR payment determinations in the past year and reported industry-leading dispute closure rates tied to the No Surprises Act's regulatory tailwinds.

Name

FHAS

Legal name

Federal Hearings and Appeals Services, LLC

Website

https://fhas.com

Company type

Private

Founded year

1996

Operating status

Operating

Headcount range

51–100 employees

Short description

FHAS (Federal Hearings and Appeals Services) is a URAC-accredited, CMS-certified IDR entity that delivers medical review, appeals management, independent dispute resolution, and hearings/adjudication services to health plans, federal and state agencies, and government contractors under the No Surprises Act framework.

Ownership category

akta.pro rank

Product category

Healthcare Dispute Resolution and Medical Review Services

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Business Support Services (5614)

SIC

Services-Health Services (8000), Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

Fraud, Waste & Abuse (FWA) Detection & SIU Support (BPAAAFAH)

akta.pro secondary industry

Claims Management & Digital FNOL Platforms (FSAGAGAC)

Keywords

• Medical review services
• Independent dispute resolution
• Appeals management
• Healthcare adjudication
• Utilization management

Headquarters

HQ city

Wilkes Barre

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Others

Revenue model

1. Independent Dispute Resolution (IDR) Services: Processing fees for IDR dispute resolution under the No Surprises Act. Fees vary by claim type and batch size, ranging from $540-$1,340 per dispute for post-June 2026 disputes. Revenue is transaction-based, earned per case processed.
2. Medical Review Services: Expert accredited reviews for health plans covering medical necessity review, utilization management, and dispute resolution. Revenue derived from professional service fees for clinical review services rendered to commercial payors and government agencies.
3. Appeals Management and Hearings: Impartial, accredited appeals handled by licensed experts, plus administrative law judge services and agency support for hearings and adjudication. Revenue from service fees for appeals processing and adjudication support.

Pricing tiers

Go-to-market motion1 record

Distribution channels1 record

Marketing channels6 records

Core offering

FHAS provides accredited medical review, appeals management, independent dispute resolution (IDR) under the No Surprises Act, hearings and adjudication services, and provider outreach and education for commercial health plans, federal and state government agencies, and government contractors. Service delivery is supported by AI/augmented-enabled intelligent platforms with workflow automation and advanced analytics, and is differentiated by dual URAC accreditations (IRO and HUM), ISO certification, and a CMS-certified IDR entity designation.

Product overview

FHAS provides a unified suite of healthcare dispute resolution and medical review services. The core offerings include Medical Review, Appeals Management, Independent Dispute Resolution (IDR), Hearings and Adjudication Services, and Provider Outreach & Education—all built on dual URAC accreditations (IRO and HUM) and ISO certification. FHAS deploys scalable, AI/augmented-enabled platforms combining automation with human expertise to deliver faster, more consistent, and cost-effective decisions for health plans, federal and state governments, and government contractors.

Differentiator

Problem solved

Functional benefit

Products and services

• Medical Review Expert, accredited reviews and coding accuracy services to cut improper payments and improve care for commercial payors, providers, and government agencies. Covers medical necessity review, utilization management, and coding accuracy as part of FHAS's URAC-accredited HUM and IRO offerings.
• Appeals Management Impartial, accredited appeals handled by licensed experts to resolve denied claims quickly for health plans, providers, and government agencies. Aims to reduce appeal overturn rates through comprehensive initial reviews and defensible decision-making.
• Independent Dispute Resolution (IDR) CMS-certified independent dispute resolution services under the No Surprises Act to settle out-of-network payment disputes fairly and compliantly. Fees are regulated by CMS and vary by dispute type and batch size, processed via the federal IDR portal.
• Hearings and Adjudication Services Compliant, efficient rulings delivered by expert administrative law judges with scalable agency support for state and federal agencies. Covers eligibility reviews, hearings, and legal adjudication for Medicaid, CHIP, and other government health programs.
• Provider Outreach & Education Targeted, personalized provider education and guidance aimed at reducing errors, improving compliance, and minimizing administrative waste in claim submissions and dispute processes.

Quantifiable outcome

• 17% ineligibility rate in H1 2025, down from 69% in early 2022
• +3 more outcomes

Named customers3 records

Segments4 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability3 records

Feature3 records

Scale indicators6 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• MultiPlan: One of the largest certified IDR entities under the No Surprises Act, also providing payment integrity and cost containment services to health plans. Most directly comparable peer given shared IDR entity status and similar customer base.
• Cotiviti: Healthcare payment integrity firm specializing in FWA detection, claims review, and accuracy solutions for health plans. Comparable in medical review and payment integrity focus, serving similar commercial payer customers.
• Zelis: Healthcare payments optimization company providing claims cost containment, payment integrity, and provider network solutions. Comparable in payment integrity and dispute resolution services to commercial health plans.
• HMS Holdings (Gainwell Technologies): Healthcare payment integrity and program integrity services company, particularly strong in Medicaid and state program FWA detection. Comparable in federal/state government healthcare program focus and medical review capabilities.
• Maximus: Federal health program administration services firm supporting Medicare, Medicaid, and VA appeals and clinical review. Comparable in government healthcare BPO services, appeals management, and adjudication support.
• Ciox Health: Health data management company providing clinical data exchange, release of information, and health information management services to providers, payers, and government. Comparable in B2B/government healthcare data services focus.
• Health Management Associates: Healthcare consulting and research firm specializing in state Medicaid, CHIP, and behavioral health program support. Comparable in state government healthcare program services, eligibility reviews, and program integrity work.

Broad incumbents

• Optum (UnitedHealth Group): Largest healthcare data and analytics company (owns Change Healthcare) offering broad payment integrity, claims processing, and population health services. Overlapping capabilities but operates at much greater scale across the entire healthcare value chain.
• ICF International: Professional services firm with substantial federal health program consulting and program integrity work. Comparable in serving CMS, HHS, and state Medicaid clients but broader portfolio including energy and environmental consulting.
• Booz Allen Hamilton: Major federal health consulting and technology firm supporting CMS, VA, and HHS on program integrity, analytics, and operations. Comparable in federal health customer base and program integrity capabilities, though much larger and diversified.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks7 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/federal-hearings-&-appeals-services
• Xx.com/FHAS_inc

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about FHAS