Medicaid Member Reconciliation · Before January 1, 2027

Two rosters that have never aligned.

The Patients you manage in your System.

The Members the Health Plan has assigned to your System.

FHG converts the Plan’s claims data into a reconciliation asset for your System — Member by Member, monthly.  No EHR access required.  This belongs on your monthly financial dashboard.
Rev Cycle 1.0 wasn’t built for this.  Build the skill and develop the muscle memory to manage these shifts — before OBBBA doubles every gap on January 1, 2027.  Four weeks to your first FHG baseline.
What FHG sees · Natively bilingual

Three populations.  One reconciliation.  Monthly.

Patients you manage that the Plan has assigned to your roster.  Patients the Plan has assigned to your roster — that you’ve never seen.  Patients you manage today — that the Plan has assigned to a competitor’s roster instead.
What FHG makes operational today

Patient populations to track — every month.

Population to track · PCP Panel Reconciliation

Members on your PCP panel — never visited.

How do you manage risk and uncertainty when tens of millions in claims charges flows through Members you’ve never seen?  This belongs on your monthly financial dashboard.

 è–•? click any node to drill into Members

SOURCE · DATA INGESTION 1 — MEMBER RECONCILIATION

Today:  29,403 Members at $1.1B, 100% unmanaged.  After the storm:  PCP continuity breaks faster — the residual grows.

Population to track · Geographic Reach

Members in-state.  Hours from any in-network PCP.

Cape Cod, the Berkshires, the far reaches of the state.  In-network on paper.  Unreachable in practice.  $21.0M in unmanaged charges — monthly tracking required.

 è–•? click any node to drill into Members

SOURCE · DATA INGESTION 2 — ZIP CODE ELIGIBILITY

Today:  1,119 Members at $21.0M.  After the storm:  doubled.

Roster to clean · Ineligible PCPs

PCPs on your roster who don’t work for you.

Long-departed.  Specialty-only.  NPIs that never worked at the TaxID.  Members assigned to clinicians who can’t deliver care.  FHG surfaces every one by name, NPI, activity, and charges.

 è–•? hover any row to see the narrative

SOURCE · DATA INGESTION 3 — PROVIDER DATABASE RECONCILIATION

Highlighted row narrated by client.  Today:  207 ineligible clinicians on this regional demo.  After the storm:  the cleanup runs every six months.

Cadence to track · Member Volatility

The volatility your books should reflect — every month.

Adds.  Drops.  Net.  FHG tracks every Member transition month over month — the kind of detail Rev Cycle 1.0 averages away.

 è–•? hover any month for the numbers · flip Storm mode to see the cadence change

SOURCE · DATA INGESTION 1 — ELIGIBILITY HISTORY

Today:  Nov / Dec outliers under continuous enrollment.  After the storm:  every month is an outlier.

Find yours.

Convert claims data into your System’s asset.
Find your Patients.  Track their Members.
Sibling Use Cases
Plan understands its network · Plan monitors redetermination · System monitors redetermination · ACO monitors shift & movement of at-risk lives · Monthly Member Reconciliation (canon)