Falcon’s AI agents evaluate activity across contracting, authorizations and medical bills, then investigate cases end‑to‑end to stop improper payments.
Fraud adapts to rules you add, and waste hides in the documents nobody reads.
As a result, your team is stuck in a reactive cycle: reading a fraction of what arrives, across disconnected systems, after the payments already went out.
How it works
Falcon provides the data infrastructure and AI agents to review your structured and unstructured data and run workflows that evaluate every case from start to finish. Your reviewers decide what counts.
Everything that decides a case
Documents, databases, regulation and your rules, ingested as is.
One model of your operation
Each record tied to its context, each rule to where it applies.
Workflows for your needs
Some report, some act, each traceable to its rule.
Every verdict refines the rules
Your reviewers decide, and the system learns from every verdict.
Why Falcon
One decision can need the history, the authorization, the contract and the bill at once. Falcon reads and relates all of it in one connected model, from the thousand-page hospitalization bill to the few-hundred-dollar expense.
Rules, tariffs and behaviors shift all year, and the model keeps up. A correction lands once and every case after runs on it, so more gets caught earlier.
Each finding states its rule and its evidence, and traces back through the chain that produced it. Verdicts from your reviewers land in the memory; the next case runs on all of it.
Falcon runs the whole payment-integrity cycle, from contract to payment. Payers and providers take the recovered value where they need it: more coverage with the same team, or straight to their financials.
Complete coverage
Falcon’s agents learn how your operation contracts, authorizes and bills, and stay ahead of regulation as it changes, so they can act on a wide range of improper activity, for payers and providers alike.
Contracting
Contract intelligence
Answers what was agreed, rate by rate.
Rate benchmarking
Compares prices across your network.
Payment variance
Finds what was billed off contract.
Value-based contract performance
Tracks each program against its terms.
Contract modeling
Simulates new terms on real utilization.
Authorizations
Prior authorization review
Evaluates each request against criteria.
Prospective medical necessity review
Checks necessity before care starts.
Concurrent review
Follows the episode while it runs.
Utilization analytics
Surfaces over- and under-use patterns.
Risk stratification
Flags high-need members early.
Bills
Medical necessity review
Validates each charge against the record.
Fraud, waste and abuse detection
Uncovers improper patterns at scale.
Claims editing
Catches coding errors and duplicates.
Claims repricing
Prices every line exactly as contracted.
Denial and appeal management
Gives every denial and appeal its reasons.
PRIVATE HEALTH PLAN · LATIN AMERICA
MEDICAL AUDIT FIRM · LATIN AMERICA
Named references are available under NDA during diligence.
Next steps