Transforming Healthcare Through Intelligent Monitoring
At Falcon Health, we're on a mission to revolutionize healthcare program integrity through advanced analytics and intelligent monitoring. Our technology ensures the right care is delivered, detects potential issues early, and maintains payment accuracy. We're building a future where healthcare works better for everyone by protecting program integrity across care delivery and reimbursement.
Our dual-track approach - From Prevention to Payment Accuracy
Creating lasting change in healthcare requires both proactive monitoring and precise payment solutions. Our groundbreaking platforms work in harmony to elevate healthcare delivery:
- Sentinel - Early Warning System. Detect emerging fraud schemes before they impact your organization through advanced pattern recognition across utilization, billing, and provider networks. Smart workflows enable rapid intervention, protecting patients and resources while providing end-to-end case management.
- Pulse - Medicare Performance Analytics. Make informed decisions with comprehensive Medicare FFS data and proprietary benchmarking. Identify exactly where you stand compared to peers with detailed MSSP and ACO REACH metrics, connecting utilization patterns to outcomes through sophisticated root cause analysis.
- Scope - Payment Intelligence Platform. Maximize revenue and minimize audit risks through advanced reconciliation. Our engine processes data across multiple CMS systems, specializing in Risk Adjustment reconciliation through RAPS, EDS, MARx, MAO-004, and other payment files—improving accuracy, cash flow, and compliance.
Why Falcon
Our AI-powered platforms deliver measurable results across three critical dimensions:
- Early Detection & Prevention. Our Sentinel platform uses advanced AI to monitor healthcare delivery in real-time, identifying anomalous billing patterns and inappropriate care protocols before they impact your organization. By analyzing provider behavior across networks, we flag potential issues for early intervention, preventing fraud, waste, and abuse proactively rather than reactively. This predictive approach protects patients from unnecessary services while safeguarding financial resources and program integrity.
- Precision Payment Reconciliation. We eliminate revenue leakage by automating complex payment processing across CMS programs and payer contracts. Our Scope platform navigates intricate payment rules from shared savings calculations to Risk Adjustment and Quality Metrics reconciliation with unmatched accuracy. By tracking claims through CMS reports like MAO-004 and other EDI transactions, we identify and recover otherwise lost revenue while maintaining ironclad compliance.
- End-to-End Program Intelligence. Transform program performance with comprehensive analytics that connect prevention to payment. Our integrated approach provides a complete view of your healthcare operations—from early warning signals to final payment reconciliation. We deliver actionable insights on quality measures, cost drivers, and attribution alongside automated alerts for discrepancies and policy changes. This unified intelligence enables strategic decision-making while simplifying regulatory documentation and audit preparation.
Discover Our Solutions
Learn more about Sentinel, Pulse, and Scope - our innovative platforms transforming healthcare monitoring and payment accuracy.
View Our SolutionsPartner 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