7-site FQHC · Mixed Medicaid MCO · 18-month wrap backlog
Two years of wrap recovered. $2.1M in eleven weeks.
A 7-site FQHC was sitting on an 18-month backlog of unpaid Medicaid wrap. The CFO had written most of it off as bad debt. It was not. It was state reconciliation owed and never billed. We rebuilt the engine, fixed the T1015 problem, and pulled the cash back.
Specialty
FQHC · Primary Care
Footprint
7 sites
Payer mix
Medicaid MCO
Engagement
11 weeks
Primary code
T1015
Backlog cleared
$2.1M wrap
RECOVERED
$2.1M
Wrap pulled back from 18-month backlog
SURFACED
4,800
Unpaid wrap entries reconciled
CLEARED IN
11 wk
Audit to backlog-zero
FOOTPRINT
7 sites
Mixed Medicaid MCO panel
The situationTwo payers. One encounter. Months apart.
TAKEAWAY
MCO pays interim. State pays the wrap. Months apart. Both must reconcile or cash dies.
INTERIM LAG
14-30d
WRAP LAG
2-4Q
UNPAID
4.8K
AT RISK
$2.4M
Leak 01 · T1015 rejection
Encounter never reached the wrap pool.
- → 3 MCOs rejected T1015 lines
- → FFS adjudication, no bundled encounter logic
- → State never saw the visit, wrap lost
Leak 02 · Wrap timing
Interim and settlement landed apart.
- → MCO interim: 14-30 days
- → State wrap: 2-4 quarters out
- → Tracked against charges, not PPS
Leak 03 · NCR vs GCR
GCR was the wrong lens.
- → PPS distorts GCR by design
- → Right metric: NCR vs PPS, by payer class
- → That report did not exist
The fix · workflowPPS rate. Interim. Wrap. Posted.
STAGE 01
PPS lock
Target rate per site
STAGE 02
Interim post
MCO pays against PPS
STAGE 03
Wrap close
State settles the gap
STAGE 04
Attributed
Audit trail per encounter
What the dashboard showsWrap aging. By MCO. With dollars.
GREEN
Healthy
Under 50% unpaid age
AMBER
Appeal trigger
50-89% aged, escalate
RED
Escalation
90%+ aged, state intervention
Wrap aging · 7 sites · all MCOs
refreshed 22s ago
Plan A · State MedicaidMCO: AmeriHealth · 1,420 units
T1015
$420K
Plan B · State MedicaidMCO: Keystone First · 1,180 units
T1015
$612K
Plan C · State MedicaidMCO: UnitedHC CP · 940 units
T1015
$548K
Plan D · State MedicaidMCO: Health Partners · 720 units
T1015
$338K
Plan E · State MedicaidMCO: PerformCare · 540 units
T1015
$182K
5 MCOs shown · 4,800 unpaid encounter units · $2.1M at risk before recovery
Engagement ScorecardWeek 11 partner report · redacted
CONFIDENTIAL
KPI movement before vs current.
NCR against PPS · Medicaid MCO
61%
94%
AR days outstanding · DOS
92 d
47 d
Wrap backlog dollars
$2.4M
$0.3M
T1015 denial rate
23%
2.1%
Unpaid encounter units
4,800
320
Cash posted with attribution
No
Yes
Week 11 · 2026
ASP-RCM Senior Partner
By site · cumulative recoveryWhere the $2.1M came from.
TAKEAWAY
Top 5 sites returned 84% of wrap. All 7 sites cleared by week 11.
| SITE | PRIMARY MCO | UNITS | RECOVERED | CLEARED |
|---|---|---|---|---|
| Site 01 · Flagship | AmeriHealth | 1,180 | $498K | Wk 9 |
| Site 02 · North | Keystone First | 920 | $412K | Wk 10 |
| Site 03 · East | UnitedHC CP | 810 | $386K | Wk 8 |
| Site 04 · West | Health Partners | 680 | $312K | Wk 10 |
| Site 05 · South | PerformCare | 540 | $244K | Wk 7 |
| Site 06 · Rural | AmeriHealth | 380 | $162K | Wk 11 |
| Site 07 · Satellite | Keystone First | 290 | $86K | Wk 11 |
| Total · 7 sites | 4,800 | $2.1M | Wk 11 |
Week-by-week · the 11-week planFour milestones. Eleven weeks. One backlog cleared.
WEEK 1-3
Audit and map
18 months of remittance pulled. Every T1015 line reconciled against PPS. Rejection taxonomy built. Unpaid wrap quantified by MCO and state.
WEEK 4-6
Reconciliation engine
Encounter ledger rebuilt with payer attribution. PPS rate locked per site. Interim and wrap tracked separately. NCR-vs-PPS report deployed.
WEEK 7-9
MCO appeals + cash
T1015 rejections appealed with payer-specific templates. State wrap files rebuilt and resubmitted for trailing two years. First $900K landed.
WEEK 10-11
Backlog cleared
Final two sites posted. AR DOS held at 47 days. T1015 denials under 2.5%. Weekly recon cadence locked. CFO now leads with NCR vs PPS.
The money was always ours. It was just hidden behind a calculation nobody was running daily.
CFO · 7-site FQHC (anonymized)
OutcomesBefore. After. In numbers.
Pre-engagement · baseline
NCR against PPS · Medicaid MCO
61%
AR days outstanding · DOS
92d
Wrap backlog dollars
$2.4M
T1015 denial rate
23%
Annualized leak ≈ $2.0M wrap unrecovered
Steady-state · week 11+
NCR against PPS · Medicaid MCO
94%
AR days outstanding · DOS
47d
Wrap backlog dollars
$0.3M
T1015 denial rate
2.1%
11-week cumulative recovery $2.1M
Capability stackWhat the engine actually runs on.
STACK
Reporting Cloud service. AR Workflow queue. LLM Gateway parses every MCO format.
LAYERS
4
AUDIT LOGS
1
Layer 04 · AI
Remittance parser · Wrap variance detection · Denial routing
▼
Layer 03 · LLM Gateway
Single audited choke point · cost meter · prompt registry
▼
Layer 02 · Platform
Reporting Cloud · AR Workflow · Reconciliation engine
▼
Layer 01 · HIPAA-eligible AWS
AES-256-GCM PHI · row-level RBAC · PHI access log
Common questionsFrequently asked: FQHC wrap.
What is the FQHC wrap?
The wrap is the difference between what a Medicaid MCO pays under its contracted fee schedule and the FQHC's certified PPS encounter rate. The state owes the FQHC the gap as a reconciliation payment. The MCO pays the interim. The state pays the wrap. The two payments arrive months apart and rarely match the same encounter ID.
Why is wrap reconciliation hard?
Three reasons. First, MCO interim and state wrap land at different times, often two to four quarters apart, with different formats. Second, MCOs reject T1015, which then never enters the wrap pool. Third, most billing systems track collections against charges, not PPS rate, so unpaid wrap ages into AR and gets written off as bad debt when it is actually owed by the state.
What is the T1015 issue?
T1015 is the bundled FQHC encounter code that anchors the wrap calculation. Several Medicaid MCOs reject T1015 because their adjudication systems are built for fee-for-service. When T1015 is rejected, the visit drops out of the wrap pool, the state never sees it, and the FQHC loses both interim and wrap.
Why anonymize the client?
The master service agreement includes reciprocal confidentiality. The numbers and timeline are real. A senior partner can walk you through methodology and host a reference call under NDA once both sides agree.
Can we get a reference call?
Yes, at late-stage diligence with client consent. The reference is typically a 30-minute call with the FQHC CFO or revenue cycle director.
How long until we see results?
The 11-week plan delivers audit, reconciliation engine activation, and MCO appeals phases. Visible AR DOS movement starts in week four. Wrap recovery cash starts landing in week seven. The $2.1M figure is cumulative through week 11.
What does the free audit look like for FQHCs?
Send 6 months of remittance data with CARC and RARC codes, your T1015 encounter log, wrap reports, and your AR aging on DOS. Inside 30 days you receive a 4-page audit covering rejected encounter taxonomy, unpaid wrap dollars by MCO, T1015 root cause, and a 90-day fix plan.
Does this only work for multi-site FQHCs?
No. The wrap reconciliation engine works at any scale. Single-site community health centers, multi-site FQHCs, and look-alikes all run the same logic. The dollar volume shifts with site count. The discipline is the same.
Want the same audit applied to your wrap?
A free 30-day audit. Send 6 months of remittance data, your T1015 encounter log, and your state wrap reconciliation reports. We return a 4-page written audit covering your rejected encounter taxonomy, unpaid wrap dollars by MCO, T1015 denial root cause, and a 90-day fix plan. Yours to keep. No SDR follow-up.