Program · FQHCs & Community-Based Behavioral Health
AI denial recovery for Federally Qualified Health Centers. Your team approves every appeal.
Your FQHC serves patients with no other options. You do the work because it's needed, not because the reimbursement is simple. The bottleneck isn't the right to recovery. It's the bandwidth to file the appeal while serving the next patient. DenialIQ drafts the appeal case; your revenue cycle staff review, approve, and file.
Federal audit and industry figures as published; sources named with each number. Pilot results are reported to pilot customers from their own data.
The problem
Why FQHCs get denied more, and appeal less.
Not because billers are lazy. Because appealing takes time your team doesn't have.
MA/Medicaid-heavy payer mix
Your patient base skews toward Medicare Advantage and Medicaid, which deny at roughly 2x the rate of traditional Medicare.
Documentation gaps payers exploit
Complex social determinants of health don't map cleanly to payer policy language, triggering "insufficient documentation" denials even when clinical necessity is clear.
Thin margins, thinner bandwidth
You appeal less often not because the case is weaker, but because a full-time denial appeal person is hard to justify on a community health budget.
How it works
Built for FQHC & CBHC workflows. AI-drafted, staff-approved.
DenialIQ plugs into your existing revenue cycle process. It doesn't replace it.
Policy-specific logic
Every MA denial gets checked against that specific plan's documented coverage criteria, not generic Medicare rules. That's part of why 95% of appealed SNF denials get overturned: the initial denials were often wrong to begin with.
Reviewable appeals, drafted for you
No switching between four systems. Pull the claim data once, and DenialIQ comes back with the policy contradiction identified and cited inside a drafted appeal.
No data without a BAA
Nothing containing patient data moves until a Business Associate Agreement is signed.
Staff stay in control
Nothing is filed without a person approving it. Drafting is the part that eats your team's hours, so that's the part DenialIQ takes — the judgment call on whether to file stays with your staff. How much of your denial queue that lets you reach is a question your own claims answer, not one we'll answer for you here.
No patient data moves until a BAA is signed.
Full audit trail on every appeal — the reasoning is visible and reviewable.
Nothing is filed until your staff review and approve it.
Built for multi-payer complexity — MA, Medicaid, and Medicare FFS.
FAQ
Questions FQHCs & CBHCs actually ask.
How do you handle privacy and security for community health organizations?
What does DenialIQ do on an appeal, and what does our staff still do?
Do you work with Medicare Advantage plans specifically? What about Medicaid?
Let's run a quick analysis of your denial backlog.
No commitment, no pitch. Send us a de-identified sample of your denial queue — reason codes, payer, CPT/DRG, dollar amounts, month of service, no patient identifiers — and within 48 hours a person will tell you which denial categories are most likely to win on appeal and roughly what they are worth. Nothing containing patient information moves until a BAA is signed, and we'll set up a secure channel when it does.
Prefer email? contact@vellix.ai
De-identified samples only, please — no patient names, dates of birth, member or claim numbers, and no claim files.