● FQHC Revenue Cycle Specialists
FQHC Billing Services for Prospective Payment and Grant Compliance
Trusted by community health centers and multi-site FQHC networks across the U.S.
97.6%
Clean claim rate
● The Real Cost of Generic Billing
FQHC billing breaks in ways general billers never catch
Every one of these is encounter revenue your center has probably already lost this month.
Missing CG modifier or G-code
A PPS encounter without the qualifying G-code, revenue code 0521, and CG modifier doesn't trigger payment — the entire bundled encounter rate is lost, not just a line item.
Per-diem rule mistakes
Two same-day visits get billed as separate encounters when they should be bundled — or a qualifying exception is missed and a legitimate second encounter never gets billed at all.
Unreconciled wraparound payments
When an MCO pays less than the full PPS rate, the state owes the difference — but only if reconciliation is filed accurately and on time. Most centers never fully collect it.
Credentialing gaps
A provider not yet fully credentialed with a payer means every encounter they deliver is at risk of denial until enrollment catches up.
Multi-state Medicaid confusion
PPS rules, APMs, and wraparound structures differ state to state — a billing team unfamiliar with your state's rules will misfile encounters on nearly every claim.
UDS reporting inaccuracies
Inaccurate encounter data doesn't just cost a claim — it risks your center's HRSA reporting and Section 330 funding.
● How We Fix It
A billing team built around the PPS model, from intake to wraparound reconciliation
We don't hand your encounters to generalists. Every coder on your account is trained specifically on FQHC PPS logic, G-codes, CG modifiers, and per-diem rules.
● Full-Service RCM
Every stage of FQHC revenue cycle management
From eligibility and credentialing to wraparound reconciliation, we run the parts of your revenue cycle that pull attention away from patient care.
Eligibility & Credentialing
Real-time Medicaid/Medicare eligibility checks and provider enrollment tracking, so coverage and credentialing gaps never turn into denials.
PPS Encounter Coding
Every encounter coded with the correct G-code, revenue code 0521, CG modifier, and supporting CPT/ICD-10 detail, by FQHC-trained specialists.
Claim Submission & Scrubbing
Every encounter scrubbed for a valid CG-modifier and G-code combination before it leaves the building — fewer rejections, faster payment.
Wraparound Reconciliation
MCO payments tracked against your full PPS rate, with reconciliation filed on schedule so the state pays every dollar of the gap.
Denial Management
Every denial diagnosed to root cause — missing modifier, encounter documentation, eligibility — corrected and appealed with required detail.
AR Management & Patient Billing
Aging encounters worked back to payment, plus clear patient statements that reflect your sliding fee discount schedule correctly.
● Built For FQHCs Specifically
We speak fluent PPS for every encounter type you see
No learning curve, no generic templates — just billers who already know the codes and rules your center runs on every day.
● Why Practices Switch to Us
What actually changes when Claim Click Solutions takes over
● The Bottom Line
What specialized FQHC billing does for your health center
What specialized FQHC billing does for your health center
No learning curve, no generic templates — just billers who already know the codes your center uses every single shift.
● Case Study
How a 6-site FQHC network recovered $1.2M in unreconciled wraparound payments
A multi-state community health network came to us with over a year of unfiled wraparound reconciliation and a 31% encounter denial rate tied to missing CG modifiers.
● Common Questions
FQHC billing FAQ
What makes FQHC billing different from general medical billing?
FQHCs are paid under the Prospective Payment System — a flat, bundled encounter rate rather than itemized fee-for-service. Every claim needs a qualifying G-code, revenue code 0521, and the CG modifier to be paid correctly, and per-diem, wraparound, and multi-state Medicaid rules add layers most general billers have never worked with.
What is a wraparound payment, and can you recover it for us?
It's the difference the state Medicaid program owes when a managed care organization pays less than your full PPS rate. Federal law guarantees the full rate, but the gap is only paid on accurate, timely reconciliation — which is exactly what we track and file for you.
How do you handle the per-diem rule for same-day visits?
We code same-day encounters against the qualifying exceptions — separate diagnoses, or a medical visit plus a qualified mental health visit — so bundling is applied correctly and no legitimate second encounter goes unbilled.
Can you bill off-site, home, and mobile-unit visits?
Yes. We document and code qualifying off-site encounters — a patient's residence, a Skilled Nursing Facility visit covered under Medicare Part A, or another approved location — with the detail needed to support medical necessity.
Do you handle credentialing and UDS reporting support?
Yes. We support provider credentialing and enrollment tracking, and we deliver encounter data formatted for your UDS reporting to HRSA, helping protect your Section 330 funding and reduce audit risk.
● Free Billing Audit
See exactly what your current billing process is missing
We'll review a sample of your recent FQHC encounters and show you where PPS and wraparound revenue is being left on the table — no cost, no obligation.