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Credentialing Case Study |
FQHC Credentialing & Enrollment
From 2 clinics to 6: FQHC billing readiness in 13 months
A 15-year partnership that guided a university-affiliated health center to federally qualified health center (FQHC Look-Alike) status and billing readiness in 13 months, with a clean audit record.
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13 mo
Planning to FQHC billing readiness
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1–2 yrs
Faster than the typical timeline
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30 → 115
Providers, across 6 clinics
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0
Credentialing findings in any HRSA audit
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15 yrs
Partnership, and counting
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The situation
A university-affiliated health center set out to become a federally qualified health center (FQHC) and unlock the enhanced Medicare and Medicaid reimbursement that FQHC status brings. It began with two clinics and about 30 providers under university governance. The FQHC Look-Alike path runs through HRSA and multiple payers, a climb most organizations take two to three years to finish, here layered on top of university structure and approval requirements that had to meet federal standards.
What HRG built
HRG's credentialing lead, Mellissa Harmon, guided the center from first planning through HRSA approval and billing readiness:
| ✓ | Aligned university-mandated structure and governance with HRSA requirements |
| ✓ | HRSA readiness, the approved scope of project, and FQHC Medicare and Medicaid enrollment |
| ✓ | Provider credentialing and privileging, including hospital privileges |
| ✓ | Medicaid wraparound preparation, commercial enrollment, and 340B eligibility |
The results
The center earned FQHC Look-Alike designation and reached billing readiness in about 13 months, from planning in April 2020 to HRSA approval effective May 2021, roughly one to two years faster than going it alone. It has never had a credentialing or privileging finding in an HRSA audit, with Mellissa taking part in every one and answering auditors directly. Fifteen years on, the FQHC has grown to six clinics and about 115 providers, and kept HRG even after the administrator who ran the relationship moved to a new practice.
"HRG and Mellissa were instrumental in guiding us through the entire FQHC process, from initial planning to approval. Their guidance has been integral to our continued success, including consistently favorable audit outcomes."
Administrator, university-affiliated FQHC (HRSA Look-Alike)
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100 percent U.S.-based credentialing and contracting. Details anonymized at the client's discretion. Outcomes reflect this client's experience and are not a guarantee of future results.