FHAS earns NCQA accreditation for utilization management

Federal Hearings and Appeals Services said July 29, 2026, that it won NCQA Utilization Management Accreditation, a three-year review that validates its clinical review processes and compliance standards. The accreditation could strengthen FHAS’s pitch to health plans, agencies and other clients that delegate medical necessity decisions and appeals work.

Why it matters: - FHAS now has another national quality credential for utilization management, a core function that affects care approvals, denials and payment decisions. - The three-year accreditation signals to health plans, government programs and healthcare organizations that FHAS’s review processes meet NCQA standards for consistency, timeliness and evidence-based decision-making. - The recognition may make it easier for partners to delegate utilization management work to FHAS with confidence in its compliance posture.

What happened: - Federal Hearings and Appeals Services, LLC said July 29, 2026, that it earned NCQA Utilization Management Accreditation. - FHAS is based in Wilkes-Barre, Pennsylvania. - The accreditation covers FHAS’s utilization management functions only. - NCQA said its review examined FHAS’s systems, process and personnel.

The details: - NCQA Utilization Management Accreditation lasts three years. - FHAS said the accreditation reflects consistent, rigorous and evidence-based utilization management processes. - FHAS said the accreditation supports appropriate care decisions and compliance with evolving regulatory and industry standards. - James Bobeck, FHAS chief executive officer, said the accreditation provides independent confirmation that FHAS processes are rigorous, timely and grounded in qualified clinical judgment. - Bobeck said the result, together with FHAS’s URAC accreditations, shows the company can make healthcare determinations fairly, consistently and at scale. - NCQA President Margaret E. O’Kane said the accreditation shows FHAS has the systems, process and personnel needed to conduct utilization management under strict quality standards. - NCQA said more details on the scope of the review are available at NCQA’s website. - FHAS said it also holds URAC Independent Review Organization accreditation, URAC Health Utilization Management accreditation and URAC Independent Dispute Resolution Entity designation. - FHAS said its services include independent medical review, utilization management, payment integrity, legal adjudication, appeals management and independent dispute resolution. - FHAS said it has served federal agencies, state Medicaid programs, commercial health plans and healthcare organizations for nearly 30 years.

Between the lines: - The new accreditation adds to FHAS’s effort to position itself as a neutral, high-compliance vendor for decisions that can affect care access and reimbursement. - The combination of NCQA and URAC credentials is meant to reinforce FHAS’s claim that it can handle clinically sensitive review work under formal quality oversight. - NCQA’s statement narrows the certification to utilization management, so the accreditation does not cover FHAS’s other business lines.

What's next: - FHAS is likely to use the accreditation in business development with payers, agencies and healthcare clients that outsource medical review and appeals work. - The company will need to maintain NCQA standards throughout the three-year accreditation period. - FHAS said more information is available at FHAS.