How would this show up in our budget, and in front of our board?

A fixed fee for one department's discovery over six to eight weeks. You leave with a workflow map and a fixed-price proposal for the first build, which you can decline, so the board sees each rebuild's price before approving spend. Grant allowability is your call.

Can you work inside our EHR and our state Medicaid portal?

That is where the hours are. Trace records how your team moves between the EHR and practice management system, the state portal, each MCO portal and the clearinghouse. The first build is scoped to remove that movement, not to add another system.

Can you take on wrap and PPS reconciliation?

For Medicaid managed care visits paid below your PPS or APM rate, we take the matching: remits and capitation reconciled to your rate, wrap claims in your state's format, short pays flagged. Your finance lead keeps rate, change in scope, cost report and settlement decisions.

What do six-month renewals and work requirements mean for our desk?

From 2027, most expansion adults renew every six months and face work requirement checks, which some states may start later. Retroactive coverage also shrinks, so a lapse costs visits you cannot rebill. We track renewals, documents and exemptions; the state and your staff decide eligibility.

Do you need access to patient records?

Where a department handles PHI, we sign a business associate agreement before Trace is installed, and named people access PHI only in your systems. Some state Medicaid and MCO contracts limit access from outside the United States, so we confirm what yours allow first.

FQHC AI Operating Partner | Reliable Group

Who we mean

Section 330 grantees and FQHC look-alikes
Multi-site centers on eClinicalWorks, NextGen or Epic through OCHIN
Centers adding dental and behavioral health sites

Where the hours go

Patients lose Medicaid at renewal and return uninsured.
Coverage rechecked in the state portal, renewal dates on a spreadsheet. Automation queues outreach before each renewal.
PPS short pays that nobody catches.
Medicaid and Medicare Advantage wraps built by hand; same-day medical and mental health visits billed as one. Automation flags short pays.
Every new front desk hire relearns sliding fee.
Pay stubs keyed by hand, insured and uninsured patients alike. AI reads income documents and drafts the pay class; authorized staff confirm.
Cash sits in denials until timely filing runs out.
Rejections and denials for eligibility, PCP assignment and timely filing, each traced by hand. AI matches each one to its fix.
The grant report depends on a February cleanup.
The calendar-year UDS report is due February 15. Blank race, language and income fields get fixed then; automation flags them at registration.
New sites and providers wait on paperwork to bill.
Verification, re-attestation, and Medicare and MCO enrollment for each provider and each new site, chased by hand. Automation tracks every file.

Flow titled where one Medicaid visit leaks cash, four steps with two done by hand today: coverage checked in the state portal, the gap below the PPS rate spotted on the MCO remit, the short pay matched and the wrap claim built by hand, and the finance lead deciding on rates. Once rebuilt, automation takes the check, the matching and the wrap claim, and the finance lead keeps the rate decisions.

What we do, and what we leave alone

One patient keyed three times is your cost to serve.

Income, coverage and MCO assignment get keyed into the EHR, the state portal and a spreadsheet, again at renewal. Charting, privileging, pay class and the patient conversation stay with authorized staff.

Before and after titled admin work moves, staff keep every decision. Before: twelve gray blocks of work done by hand today, including portal eligibility, the renewal spreadsheet, pay stubs keyed, pay class set, Medicare code rejects, wrap claims, Advantage plan wraps, clearinghouse rejects, denial tracing, UDS field fixes and credential renewals. After: automation runs eligibility, renewals and the wrap; AI reads pay stubs and matches denials; authorized staff confirm pay class and appeals.

What we build and run

Coverage worked early, the wrap built from every remit.

Automation checks eligibility before each visit and queues renewal outreach; AI drafts each pay class for authorized staff to confirm. Run by us; the workflows stay yours.

How we work across provider operations

Medical-supply distribution

Healthcare services

ProKure Digital: a supplier to FQHCs

A distributor serving hospitals, FQHCs and clinics on federal program pricing.

20-plus people in six months

realized

No health center engagement is published yet.

What transfers: Team setup only, not eligibility, wrap or sliding fee work.

See the measured results

A six-month timeline filling to a dedicated team of 20-plus people.

First-call questions

A fixed fee for one department's discovery over six to eight weeks. You leave with a workflow map and a fixed-price proposal for the first build, which you can decline, so the board sees each rebuild's price before approving spend. Grant allowability is your call.
That is where the hours are. Trace records how your team moves between the EHR and practice management system, the state portal, each MCO portal and the clearinghouse. The first build is scoped to remove that movement, not to add another system.
For Medicaid managed care visits paid below your PPS or APM rate, we take the matching: remits and capitation reconciled to your rate, wrap claims in your state's format, short pays flagged. Your finance lead keeps rate, change in scope, cost report and settlement decisions.
From 2027, most expansion adults renew every six months and face work requirement checks, which some states may start later. Retroactive coverage also shrinks, so a lapse costs visits you cannot rebill. We track renewals, documents and exemptions; the state and your staff decide eligibility.
Where a department handles PHI, we sign a business associate agreement before Trace is installed, and named people access PHI only in your systems. Some state Medicaid and MCO contracts limit access from outside the United States, so we confirm what yours allow first.

Sources for the rules and deadlines on this pagechecked November 1, 2026

FQHC look-alikes meet Health Center Program requirements without section 330 funding. HRSA Health Center Program Compliance Manual, chapter 1, checked November 1, 2026
Medicare FQHC claims on type of bill 77X are rejected without an FQHC payment code (G0466, G0467, G0468, G0469 or G0470). Noridian JF Part A, reason code W7088, checked November 1, 2026
Medicaid wraparound: the state pays the difference between the PPS or APM rate and the managed care payment. CMS State Medicaid Director letter SMD 16-006, checked November 1, 2026
Medicare Advantage supplemental (wrap) payment when the MA contract rate is below the Medicare PPS rate. Noridian JF Part A, Medicare Advantage Wrap-Around Payment, updated June 26, 2026, checked November 1, 2026
Medicare FQHC cost reports set the payment rate and reconcile interim payments. CMS MLN006397, Federally Qualified Health Center, March 2026, checked November 1, 2026
Health centers run a sliding fee discount program that assesses every patient for income and family size; eligible insured patients pay no more out of pocket than their pay class allows, subject to payer contracts. HRSA Health Center Program Compliance Manual, chapter 9, checked November 1, 2026
Same-day medical and mental health visits are paid as separate Medicare FQHC visits (G0469, G0470); otherwise same-day visits count as one. CMS MLN006397, Federally Qualified Health Center, March 2026, page 6, checked November 1, 2026
The UDS report covers the calendar year and is due February 15 of the next year (CY2026 report due February 15, 2027). HRSA, 2026 UDS Manual, checked November 1, 2026
Health centers verify licensure and set their own credentialing and privileging approval authority. HRSA Health Center Program Compliance Manual, chapter 5, checked November 1, 2026
Each new in-scope health center site is added to Medicare enrollment on its own application. HRSA, Maintaining an Accurate Scope of Project, last reviewed June 2023, checked November 1, 2026
Starting in 2027, states redetermine Medicaid eligibility every six months for most expansion adults. HFMA, March 11, 2026, on H.R. 1 section 71107, checked November 1, 2026
For Medicaid applications on or after January 1, 2027, retroactive coverage shrinks for most applicants. Justice in Aging, April 9, 2026, on H.R. 1 section 71112, checked November 1, 2026
Medicaid work requirements for expansion adults start January 1, 2027, with possible state extensions to no later than December 31, 2028. KFF, work requirement provisions in the 2025 reconciliation law, checked November 1, 2026
Some state Medicaid and managed care contracts restrict work or data outside the United States. McDermott Will & Schulte, July 1, 2025, checked November 1, 2026

Rules change and vary by program, state and contract. Your compliance team confirms what applies to you.

How we handle regulated data

Design posture, not certification

Request documentation

BAA: Where a department handles protected health information, we execute a business associate agreement before Trace is installed or any data is accessed.
HIPAA: We execute a Business Associate Agreement before any engagement that touches PHI, and PHI is accessed only inside client-controlled systems by named individuals. Our first healthcare engagement under BAA is in progress.
Posture: Ready and aligned describe design posture, not certification. Reliable Group does not currently hold SOC 2 or ISO 27001 certification; our teams operate inside client-certified environments under client controls.
Notice: We deploy Trace only after your organization has given team members the written notice required in your state; we provide the notice template.

Your client-specific workflows, data and documentation are yours. Trace is Reliable Group software, licensed under the engagement; third-party tools keep their own license terms.

Last reviewed October 2026

Next step

Stop guessing how your operation works.

Tell us which department eats the most hours. We will say candidly whether measuring it is worth it.

Talk to us How we start

Where the hours go

Patients lose Medicaid at renewal and return uninsured.

PPS short pays that nobody catches.

Every new front desk hire relearns sliding fee.

Cash sits in denials until timely filing runs out.

The grant report depends on a February cleanup.

New sites and providers wait on paperwork to bill.