FQHC medical billing for Southern California health centers.
We handle the Medi-Cal billing that generic companies get wrong: PPS encounters, wrap-around reconciliation, and California's APM. Every dollar you earn through patient care, collected. Serving California health centers since 1988.
What is FQHC medical billing?
FQHC medical billing is the specialized process of coding, submitting, and reconciling claims for federally qualified health centers under Medi-Cal and Medicare rules. It covers per-visit PPS payments, wrap-around supplemental payments, California's APM, sliding-fee billing, and UDS reporting. Getting it right protects the revenue that funds patient care, and getting it wrong quietly costs a health center money every month.
What our FQHC billing service covers.
End-to-end revenue cycle for community health centers, built around the way you actually get paid.
Why health centers move their billing to us.
Health centers get paid in ways that trip up regular billers. Here is where the money usually leaks, and what we fix.
Denials get resubmitted, not resolved
A generic biller pushes the same claim through again and again. We find why it denied and fix the cause.
Wrap-around money left on the table
Supplemental Medi-Cal payments go unclaimed. That is revenue you earned through patient care and never see.
Claims age off before they are paid
Miss the Medi-Cal filing window and the claim is gone for good. We work A/R before the clock runs out.
"Our billing manager just quit"
When one person holds all the knowledge and leaves, payments stall. We are a team, so your revenue does not depend on one desk.
We know how California health centers actually get paid.
FQHC reimbursement does not work like a normal doctor's office. These are the rules a generic billing company was never built to handle, and the ones we work in every day.
PPS & encounter-based billing
Health centers are paid a fixed per-visit rate under the Prospective Payment System, not per procedure. Coding the encounter correctly is what protects that rate.
Wrap-around & supplemental payments
Medi-Cal managed care often pays less than your PPS rate, and the state reconciles the difference. We track and recover that wrap, the money most billers quietly miss.
California's APM (PMPM)
California's Alternative Payment Methodology, live since July 2024, pays participating centers a per-member-per-month capitated rate instead of per visit. We bill and reconcile under both models.
FQHC G-codes & specialty visits
FQHC-specific encounter codes (G0466 to G0470), behavioral-health and dental visits, and second same-day visits all have rules that decide whether you get paid.
Sliding-fee, UDS & HRSA rules
Sliding-fee discount billing and clean encounter data keep your UDS report and Health Center Program funding on solid ground.
Southern California managed-care plans
We bill L.A. Care, Health Net, IEHP, CalOptima, Molina, Community Health Group, Blue Shield Promise, and Gold Coast, and we know each plan's rules.
Primary sources: the Medicare FQHC Prospective Payment System (CMS), Medi-Cal FQHC reconciliation and the APM (California DHCS), and UDS & Health Center Program requirements (HRSA).
Specialist vs in-house vs a generic billing company.
All three can send a claim. Only one is built for how a California FQHC gets paid.
| Capability | MedBillPartner | In-house billing | Generic billing company |
|---|---|---|---|
| Medi-Cal PPS & wrap-around expertise | YesCore of what we do since 1988 | VariesDepends on one or two staff | RarelyBuilt for regular practices |
| California APM (PMPM) handling | Yes | Varies | No |
| Root-cause denial fixing | YesWe resolve, not just resubmit | LimitedTime and staffing dependent | Resubmit only |
| Southern California managed-care knowledge | YesEvery SoCal Medi-Cal plan | Local only | Generic |
| Reporting transparency for leadership | YesReal-time Medi-Net reporting | Varies | Varies |
| Continuity if staff leave | YesA team, not one desk | At riskKnowledge walks out the door | Varies |
| Scales without new hires | Yes | Hire & train | Yes |
The numbers we manage and report.
We watch the metrics that decide your net collections, and we show them to your leadership every month through Medi-Net: clean-claim rate, first-pass denial rate, days in accounts receivable, wrap-around recovery, and net collections. No black box.
Health centers stay with us for years.
The clearest sign we get you paid: clients who keep us for 7, 8, even 10 years.
Catholic Healthcare West / California Family Care
When they were our client, we handled all of their Medicare and Medi-Cal billing across clinics and health centers, tracked every payment in real time, and recovered charges that were slipping through. Full story in development.
Read the storyBest company to handle medical billing ever. They take everything off your plate while offering the best service and performance I have ever seen.
Change billers without losing a dollar.
A safe, staged switch that keeps your Medi-Cal money coming in the whole way through.
Free revenue checkup
We review your denials and unpaid claims to show where money is leaking. No cost, no commitment.
We run alongside you
We work next to your current setup so nothing is dropped during the transition.
We take over
We handle your billing, work your old unpaid claims, and clean up the backlog.
We keep improving
Clear monthly reporting and steady work to cut denials and collect more.
Most health centers see fewer denials and faster payments within 60 to 90 days. See how the transition works.
Explore FQHC billing.
Denial Management
Resolve, do not resubmit → Sub-servicePPS & Wrap-Around Reconciliation
Recover the money most billers miss → GuideCalifornia's FQHC APM Explained
The 2024 PMPM shift → GuideThe FQHC PPS Rate, Explained
How per-visit pay works → GuideHow to Switch FQHC Billing Companies
The 60 to 90 day plan → Related serviceCommunity Health Center Billing
For CHCs & Look-Alikes →FQHC billing questions.
Do you specialize in FQHC billing?
Yes. Federally qualified health centers, FQHC Look-Alikes, and community clinics are the core of what we do. We handle the Medi-Cal PPS, wrap-around, and APM rules that generic billing companies were never built for, and we have done it in California since 1988.
How do you handle Medi-Cal PPS and wrap-around payments?
We bill your per-visit PPS rate to Medi-Cal and Medicare, then track the wrap-around, the supplemental payment that covers the gap when managed care pays less than your rate. We reconcile it so your center collects its full, correct amount rather than leaving that money behind.
Can you bill under California's APM (PMPM)?
Yes. California's Alternative Payment Methodology, live since July 2024, pays participating health centers a per-member-per-month rate instead of per visit. We bill and reconcile under both the traditional PPS model and the APM, so your reporting and reconciliation stay accurate either way.
How do you actually reduce claim denials?
We fix the root cause instead of just resubmitting. Every denial is worked back to why it happened, whether that is coding, eligibility, or a plan-specific rule, and we correct the process so the same claims stop denying. Fewer repeat denials means more of your earned revenue is collected.
Do you serve health centers across all of Southern California?
Yes. We focus only on Southern California, including Los Angeles, Orange, San Diego, Riverside, San Bernardino, Ventura, and Imperial counties. That focus is why we know each county's Medi-Cal managed-care plans and rules better than a national company would.
How does switching FQHC billing companies work?
We start with a free revenue checkup, run alongside your current setup so nothing is dropped, then take over and clean up your old unpaid claims. Most health centers see fewer denials and faster payments within 60 to 90 days of the switch.
See how much more your health center could collect.
Book a free revenue checkup. We will show you where Medi-Cal money is leaking before you commit to anything.
Last reviewed: July 2026