Find the Medicaid revenue your health center is losing.
Denied claims, patients dropped at redetermination, PPS wraparound gaps — the money leaks out in places monthly reports don't show. We analyze your remittance and eligibility data and put a number on it. Built for FQHCs, look-alikes, rural health clinics, and CCBHCs.
The squeeze is real, and it tightens in 2026.
When nearly half your revenue is Medicaid and your patients must re-prove eligibility twice a year, coverage churn stops being an enrollment problem and becomes a revenue cycle problem. Most health centers don't know what it's costing them, because the losses show up as self-pay visits and quiet write-offs — not as a line item.
The Offer
The Medicaid Revenue Diagnostic
A fixed-scope analysis of roughly twelve months of your remittance, claims, and eligibility data. Not a software subscription, not an open-ended consulting engagement — a defined piece of work with a defined deliverable.
Denial & write-off analysis
Every denial categorized by root cause and recoverability — eligibility, coding, timely filing, authorization — with the dollars attached.
Coverage churn exposure
How many of your Medicaid patients lost coverage at redetermination, what those visits became, and what semi-annual redeterminations will do to that number.
PPS & wraparound gaps
MCO payments reconciled against your PPS rate to find systematic underpayment in the wraparound.
Unbilled encounter scan
Visits that never became clean claims — retro-eligibility misses, sliding-fee misclassification, charge lag.
CFO-ready findings report
Quantified leakage by category, benchmarked against your payer mix — a document you can take to your board.
Prioritized recovery plan
What to recover, in what order, with what effort — whether you act on it in-house or with us.
Pricing is fixed-scope and discussed on the review call — sized to your organization, aligned to what the diagnostic finds. If your revenue cycle is already tight, we'll tell you that too.
How it works
Three steps, no disruption to your billing team.
Revenue review call
30 minutes with your CFO or finance lead. We walk through your payer mix, billing setup, and where you suspect the leaks are. No pitch deck.
Secure data pull
Under a BAA, we work with your billing lead to export 835 remittances, AR and denial reports from your PM system, and eligibility files. A few hours of their time, total.
Findings & recovery plan
Within a few weeks: the quantified findings report and a working session to walk your leadership through it — what’s recoverable, what’s preventable, and what to do first.
Safety-net specific. AI-native. Methodology in the open.
We work exclusively in community health, where the billing rules — PPS rates, wraparound reconciliation, sliding fee, UDS — are nothing like private-practice billing. Our analysis runs on AI-native tooling, which is why a diagnostic that would take a consulting team a quarter takes us weeks. And like everything LumenHealth publishes, the methodology is disclosed — every finding in your report is traceable to your own remittance data, not a black-box estimate.
Thirty minutes. Your payer mix, your numbers, no pitch.
Built for CFOs, finance directors, and billing managers at FQHCs, look-alikes, rural health clinics, and CCBHCs. If the diagnostic isn't a fit, the call will still tell you where to look.
Diagnostic findings are estimates derived from your historical data; actual recovery depends on payer adjudication and your state's Medicaid rules.