The AI Revenue Integrity Layer for FQHCs & Billing Companies
Automate PPS wraparounds, same-day integrated care rules, and state-specific Medicaid managed care. Our platform integrates with your existing EMR and clearinghouse to prevent denials at scale.
Built for High-Volume Automation
Our multi-tenant engine is designed specifically for FQHCs and outsourced billers. We automate complex workflows to drastically reduce manual labor and improve revenue capture.
- 100%
- Automated Wraparound Math
- Multi-EMR
- Single Integration Point
- 90%+
- Auto-Fix Rate on Rule Violations
Solving the Hardest FQHC Challenges
AI-Powered Clinical Coding
Extract precise CPT and ICD-10 codes directly from encounter notes. The AI engine captures all billable services and diagnoses, ensuring clinical accuracy before applying FQHC-specific billing rules.
Same-Day / Integrated Care Logic
Automatically determine when medical and behavioral health visits qualify as separate encounters. The system applies appropriate modifiers (25, 59) and documents the rule basis to maximize revenue.
Automated PPS & Wraparound Math
Eliminate manual reconciliation. The platform computes the PPS rate, extracts the MCO payment from the 835, calculates the exact wraparound owed, and generates the reconciliation claim.
Pre-Submission Denial Prevention
Scrub claims against state-specific Medicaid rules, such as CA Medi-Cal, before submission. Predict and resolve denial reasons before the claim leaves your system.
The "Embeddable Firewall" Architecture
Multi-Tenant & Multi-EMR
Ingest encounters from OCHIN Epic, eClinicalWorks, and NextGen into a single schema. Manage multiple FQHC clients from one dashboard without per-clinic implementations.
- One integration, many EMRs
- Cross-client denial root-cause trending
- No per-clinic implementation fees
Clearinghouse Syncing
Integrate with your existing clearinghouse, such as Waystar or TriZetto. Automatically ingest 835s, categorize denials by root cause, and generate evidence-based appeals and wraparound claims.
- Automated 835 parsing
- Zero-touch wraparound generation
- Evidence-based appeal drafting
The Complete Guide to FQHC Revenue Cycle Management
Want to dive deeper into the mechanics of FQHC billing? Read our comprehensive guide covering the structural challenges of PPS rates, sliding fee scales, and 340B program compliance.
Read the GuideUnderstanding Wrap-Around Complexity
Navigating Same-Day Integrated Care
HRSA Compliance & UDS Reporting
Frequently Asked Questions
See the FQHC Demo
Request a demo to see our interactive FQHC Command Center in action, featuring live workflow automation and state-specific rules engines.
The Demo Golden Path Includes:
- Multi-EMR intake (OCHIN Epic, eCW, NextGen)
- Same-day integrated care logic execution
- Live PPS + Wraparound math calculation
- Pre-submission denial prevention
SOC 2 Compliant • BAA Standard • HIPAA Compliant