Built for high visit volume, Medicaid churn, and payer scrutiny, to keep claims clean and cash predictable.
Primary care and FQHC revenue cycle management (RCM) keeps your claims flowing from eligibility and charge capture through denial prevention, payment posting, and A/R follow-up, so high patient volume and insurance changes don't turn into delayed reimbursements or write-offs.
Primary care and FQHC billing is a high-volume, high-variation environment. A single error at the front end (coverage, demographics, authorization, provider identifiers, plan rules) can ripple through the entire revenue cycle, creating rework, denials, and aging A/R.
In 2025, many organizations experienced a "resource triage" reality: teams prioritized easy claims and let tougher accounts age. In 2026, churn and payer validation pressure makes that approach expensive. We help you stabilize collections using repeat eligibility checks, clean-claim validation, fast A/R cadence, and root-cause prevention loops.
Our approach is practical: we reduce rework at the source, keep claims moving, and use reporting to prevent repeat denials.
Benchmarks depend on payer mix, state Medicaid rules, and system configuration. We baseline your KPIs during onboarding and set measurable SLAs.
Eligibility + Insurance Discovery
Demographics + COB QA
Charge Capture + Coding Review
Scrubbing + Clean Claim Submit
ERA/EOB Posting + Exceptions
Denials + A/R Follow-up Cadence
Dashboards + Prevention Loop
Designed to reduce churn denials, protect timely filing, and keep high-volume claims moving.
| Metric Area | Before IntegraRCM | After IntegraRCM |
|---|---|---|
| Eligibility / churn denials | Coverage gaps discovered after submission; repeated rework | Repeat eligibility checks + exception routing before submission |
| Front-end rejections | Demographic errors, plan selection issues, missing IDs | Registration QA + standard edits to keep claims clean |
| A/R aging & timely filing risk | Denied claims age; follow-up cadence inconsistent | Structured cadence + worklists to prevent filing-limit losses |
| Small balances | Under $100 ignored; accumulates silently | Rules-based strategy to recover efficiently without overload |
| Reporting & prevention | Static snapshots; repeat denial patterns persist | Dashboards + root-cause loops to reduce repeat denials |
Primary Care and FQHC organizations often run on a mix of EHR/PM systems and clearinghouses. Our workflow is built to align with your existing technology, whether you're centralized on one platform or operating across multiple sites with different configurations.
We support FQHC workflows typically seen with OCHIN Epic environments: consistent registration QA, coverage verification, charge routing, claim edits, remittance posting, and denial workqueues aligned to your operational model and payer mix.
For Epic clinics, we align to your charge capture processes, edit logic, and remittance posting rules to reduce rework and improve claim cleanliness while keeping A/R follow-up consistent and measurable.
For Cerner environments, we work within your claims workflow and remittance processes and implement a consistent denial and A/R work strategy to reduce aging buckets and protect timely filing.
High-volume clinics using athenahealth benefit from workflow standardization: eligibility checks, claim edits, denials follow-up, and payment posting processes that keep throughput high without sacrificing accuracy.
In eCW setups, we focus on front-end data quality, claim scrub consistency, and fast denial correction to prevent claims from aging into uncollectible buckets.
For NextGen, AdvancedMD, and other PM systems, we adapt to your claims, posting, and denial workflows and provide a consistent operational blueprint that drives measurable improvement.
If you have a hybrid environment (multiple EHR/PMs across sites), we map workflows per location and roll them into a unified KPI dashboard.
Client: Multi-site Primary Care + FQHC-style clinic network with high Medicaid volume, frequent plan changes, and heavy visit throughput.
Implemented repeat verification at critical points: scheduling, check-in, and pre-bill, catching coverage changes early.
Standardized demographic QA, plan selection validation, and COB updates to reduce rejections and payment delays.
Put front-end edits in place to prevent common claim errors that trigger avoidable denials and rework.
Segmented A/R buckets and established a consistent follow-up cadence to protect timely filing and recover high-yield balances.
Note: Results vary by payer mix, state policy, clinic configuration, and documentation patterns. We define KPIs during onboarding and report against SLAs.
| Model | Description | Best Fit |
|---|---|---|
| Hybrid RCM Support | We take targeted workflows (eligibility churn, denials, aged A/R) while your team keeps core operations. | Clinics needing immediate relief without full outsourcing |
| Dedicated Team / FTE Model | A dedicated team aligned to your systems, volume, and reporting cadence, with SLA-managed throughput. | Multi-site clinics and FQHC networks |
| Full Revenue Cycle Partnership | End-to-end delivery including eligibility workflows, claims, posting, denials, A/R, and performance reporting. | Organizations wanting unified accountability |
Each engagement starts with onboarding: baseline KPI audit (denial drivers, A/R aging distribution, first-pass rate), workflow mapping, and SLA definition.
Many organizations see early momentum in 30–60 days (throughput + backlog reduction), with deeper improvements as prevention loops mature.
We reduce eligibility denials by repeating verification at scheduling, check-in, and pre-bill, then routing exceptions into workqueues for correction before claim submission. This prevents avoidable rejections caused by coverage churn and missing plan data.
A clean claim is complete, accurate, and compliant on first submission, including demographics, payer details, proper diagnosis-to-procedure linkage, provider identifiers, modifiers/units where needed, and any payer-required data elements.
A/R often ages quickly when eligibility changes mid-cycle, COB is incorrect, denials follow-up isn't segmented, or staffing constraints push older claims into "later" queues. A consistent cadence and prioritized worklists prevent stagnation.
Primary care and FQHC KPI focus typically includes clean claim rate, denial rate, days in A/R, A/R over 90 days, net collection rate, and posting turnaround time, plus top denial root causes by payer.
Yes. We use rules-based strategies to efficiently recover small balances without overwhelming staff, combining statement cadence, outreach workflows, and prioritization so "under $100" doesn't become a silent write-off bucket.
Yes. We align to common systems used by clinics and FQHCs, including OCHIN Epic, Epic, Cerner, athenahealth, eClinicalWorks, NextGen, and other PM platforms, mapping workflows to your configuration and payer mix.
Primary care and FQHC revenue cycle management (RCM) keeps your claims flowing from eligibility and charge capture through denial prevention, payment posting, and A/R follow-up, so high patient volume and insurance changes don't turn into delayed reimbursements or write-offs.
Eligibility denials often happen because coverage changes between scheduling and the date of service, COB is outdated, or key payer fields are missing. A churn-aware workflow uses repeat verification and exception routing before claim submission.
We segment denials and rejected claims into worklists, enforce a consistent follow-up cadence, and prioritize claims nearing filing deadlines. This prevents small issues from aging into unrecoverable losses.
We align workflows to common systems used in primary care and FQHC environments, including OCHIN Epic, Epic, Cerner, athenahealth, eClinicalWorks, NextGen, and other practice management platforms.
Yes. Accurate payment posting keeps A/R current and triggers denial/underpayment work sooner. We also manage denials and A/R follow-up using prioritized queues and reporting to reduce repeat issues.
Many organizations see early traction in 30–60 days through backlog reduction and faster follow-up, with deeper revenue integrity improvements as prevention loops mature.
We'll review a recent sample of claims and A/R to identify churn denials, front-end rejection drivers, aging bucket risks, and fast-win prevention opportunities — then deliver a KPI baseline with recommendations.
Audit reports are typically delivered within 10 business days.