FQHC Billing Cash Flow
Your health center bills encounter-based PPS rates across managed Medicaid, Medicare, and commercial payers, and reimbursement runs well beyond 30 days.
Where your cash goes on encounter billing, and how Copay closes the gap.
A patient encounter happens
Your providers deliver a face-to-face visit, and every patient is seen regardless of ability to pay.
Patient encounter
Established patient visit
You bill the FQHC encounter rate
Your team submits the encounter claim at your PPS rate through your existing software, exactly as you do today.
Visit G0467 · Centene · $215.00
Encounter claimPPS rate
Managed Medicaid and commercial payers review for weeks
Encounter reimbursement from managed Medicaid and commercial plans lands long after the visit, while grant timing rarely lines up.
Copay pays the next business day
Copay purchases the eligible encounter claim and deposits the capital the next business day, by ACH.
Deposit from Copay
ACH · Next business day
The FQHC encounter codes Copay purchases.
Copay prices each encounter claim individually at the service line, using how that specific code performs with your payer, rather than a blended portfolio average.
Every eligible FQHC encounter code is funded the next business day.
Federally qualified health center (FQHC) visit, new patient; a medically necessary, face-to-face encounter between a new patient and an FQHC practitioner
PurchasedFederally qualified health center (FQHC) visit, established patient; a medically necessary, face-to-face encounter between an established patient and an FQHC practitioner
PurchasedFederally qualified health center (FQHC) visit, IPPE or AWV; an FQHC visit that includes an initial preventive physical examination or annual wellness visit
PurchasedFederally qualified health center (FQHC) visit, mental health, new patient; a medically necessary, face-to-face mental health encounter with a new patient
PurchasedFederally qualified health center (FQHC) visit, mental health, established patient; a medically necessary, face-to-face mental health encounter with an established patient
PurchasedCapital that fits the way health centers actually run.
Encounter revenue
Fund encounter revenue without the wait.
Each eligible encounter is funded the next business day, so your center is not waiting weeks on managed Medicaid and commercial payers to pay each visit. Copay covers the eligible encounter claims behind your operating budget.
Every payer
Across Medicaid, Medicare, and commercial.
Copay purchases eligible encounter claims billed to Medicaid and Medicaid managed care, Medicare, and commercial plans, so the next-business-day deposit covers the payer mix your health center actually runs.
Non-recourse
A denied claim is our risk, not yours.
Non-recourse means a denied eligible claim is Copay's loss. If a purchased FQHC encounter claim is denied after the fact, your capital is not clawed back.
FQHC billing, answered.
No. Copay is not a loan, not factoring, and not a merchant cash advance. Copay purchases your eligible FQHC claims outright and deposits funds the next business day, with no debt and no repayment schedule.
FQHCs bill encounter-based PPS rates, a per-visit rate under the Medicaid Prospective Payment System and a Medicare FQHC PPS rate, rather than standard fee-for-service. Managed Medicaid and commercial payers can take well beyond 30 days to pay each encounter. Copay purchases your eligible encounter claims and funds them the next business day, so cash does not lag behind the visits and grant timing.
Community health center revenue runs through Medicaid and Medicaid managed care plans such as Centene and Molina, Medicare, and commercial plans including UnitedHealthcare and Aetna. Copay purchases eligible encounter claims billed to those payers, so the next-business-day deposit covers the bulk of your center's volume.
No. You connect your billing software once and submit encounter claims exactly as you do today, with your sliding-fee documentation unchanged. Copay purchases the eligible billed claims behind that work, so your center keeps serving every patient regardless of ability to pay while the cash arrives the next business day.
Non-recourse means a denied eligible claim is Copay's loss, not yours. If an eligible purchased FQHC encounter claim is denied or downcoded after the fact, Copay absorbs the loss with no clawbacks against your health center.
From submitted claim to funded account.
While insurance takes 30 to 90 days, Copay moves in one.
Step 01 · Submit
You submit your claims as normal
Nothing changes about how your billing team works.
Claim #18473
DOS 02/04/24
Federally qualified health center (FQHC) visit, established patient; a medically necessary, face-to-face encounter between an established patient and an FQHC practitioner
Step 02 · Verify & Price
We verify and price in real time
Copay checks payor history and prices the claim at the CPT level.
Underwriting in progress
Step 03 · Approved
Advance approved
Capital is approved and scheduled for next business day deposit.
Advance Approved
$3,000
Net advance
Step 04 · Funded
Capital in your account
While the payor takes 30 to 90 days, you already have your capital.
Your account
$0
Available balance
Copay reconciles automatically when the payor pays. You do nothing.
Get paid on your health center claims the next business day.
Copay purchases your eligible FQHC claims. No loans, no personal guarantee, no workflow change.