Coverage Management Platform Reviews & Product Details

Pointcare is the coverage management platform built for community health centers, FQHCs, and safety-net providers. Powered by Coverage Intelligence™, Pointcare checks the eligibility of every patient continuously, predicts who is about to lose Medicaid, Medicare, or Marketplace coverage, and then acts on it. Patients get co-branded, multilingual outreach and help submitting their paperwork. Your staff gets a live view of where every member stands. And you recover revenue from past visits you can still bill. Instead of finding out about a lapse when a claim denies, your health center finds out the month it happens and reaches the patient before the next visit. THE PROBLEM POINTCARE SOLVES For many health centers, Medicaid makes up 40–70% of revenue, so lost coverage is a financial problem as well as a patient-care problem. When a patient lapses, a visit that would be reimbursed at the full PPS rate becomes a sliding-fee visit worth a fraction of that. Health center finance leaders tell us that a 1% drop in Medicaid membership can cost roughly $250,000 a year. Most of those losses are preventable. The large majority of Medicaid lapses are procedural: a missed notice, an address change, a form that never got returned. The patient is still eligible. Health plan redetermination lists are often incomplete or wrong, state eligibility updates can lag by 30–90 days, and enrollment teams are stretched thin. Manual work can take 15–45 minutes per patient, and many teams reach only a small share of the patients who need to renew. H.R. 1 makes this harder. Expansion adults move to redeterminations every six months, which doubles renewal volume. Community engagement (work) requirements of 80 hours a month begin in January 2027, and new verification rules keep adding complexity. Coverage management used to be a once-a-year project. Now it's a permanent, ongoing operation, and spreadsheets and worklists can't keep up. HOW COVERAGE INTELLIGENCE WORKS Coverage Intelligence™ is the engine behind every Pointcare product. The Coverage Intelligence ™ Engine continuously captures billions of coverage signals from the patients under Pointcare's coverage management: current and historical coverage checks, aid code changes, plan and MCO changes, and, to tune it to your own members, any data your clinic provides. On its own, that data is noise. The engine turns it into signal: a redetermination date, and the next logical step to get that patient back to coverage. WHAT POINTCARE DOES Pointcare manages coverage across the whole patient lifecycle: keeping patients covered, getting uninsured patients covered, and moving patients between programs when their eligibility changes. • Redeterminations: Awareness and assistance campaigns timed to each member's renewal date, with state-specific submission pathways. Pointcare checks renewal dates itself instead of relying only on health plan lists. • Lapse Detection and Recovery: Monthly sweeps catch the moment a member goes from Active to Inactive, and both the clinic and the patient are notified at the same time. Recovery outreach starts automatically, including for members who never responded to a reminder. • Work Requirements: Identifies expansion adults subject to community engagement rules, screens for exemptions such as medical frailty, and runs the 80-hour compliance workflow so patients don't lose coverage over paperwork. • Self-Pay Conversion: Regular outreach to uninsured and self-pay patients. Pointcare screens for Medicaid first and routes everyone else to the Marketplace. • Coverage Transitions: When a patient is no longer eligible for Medicaid, Pointcare helps move them to Marketplace or Medicare coverage so they stay insured and stay with your health center. • Medicare Enrollment: Outreach to patients turning 65 starting 12 months before they're eligible, plus Annual Enrollment Period campaigns for plan optimization and D-SNP alignment. • Retroactive Recovery: Pointcare checks your past uninsured and self-pay encounters against Medicaid eligibility and gives you a list of visits you can bill. These are visits where the patient was covered but was recorded as self-pay. Retroactive recovery often produces revenue in the first 30 days and frequently covers the full cost of the service. • Household Coverage: When Pointcare engages one patient, it looks at coverage across the whole household, which often turns up uninsured dependents who can be enrolled. THE POINTCARE PATIENT APP The Pointcare Patient App is a web and mobile app branded with your health center's name, so patients can see, manage, and act on their coverage in one place. Patients can check their coverage status, see upcoming renewal and work requirement deadlines, get reminders in their preferred language, and take the next step on an application or renewal, any time of day and from any phone. Patients can reach the app through outreach links or a QR code at the front desk, which makes enrollment available outside clinic hours and outside appointments. Because the app carries your brand, patients see their own health center, not an unfamiliar vendor, which builds trust and engagement. Every action a patient takes in the app feeds back into Coverage Intelligence and your clinic dashboard. PROVEN OUTCOMES Pointcare's results are measured against public, independently checkable data, not just numbers we report ourselves: • HRSA Uniform Data System (2023–2025): The median community health center's Medicaid enrollment fell 4.4%. Over the same period, the median health center using Pointcare grew its Medicaid enrollment by 6.6%. 63% of Pointcare health centers grew, compared with 40% of the field. BUILT FOR THE WAY HEALTH CENTERS WORK • Extends your team rather than replacing it: Automation handles routine monitoring and outreach, and your navigators and enrollment counselors focus on the complex, high-touch cases that need a person. • Your brand, your patients: Outreach, materials, and the Patient App are co-branded with your health center, so patients hear from you. • Fast implementation: Most health centers go live in 2–3 weeks, and no EHR integration is required to start. • State-specific expertise: Workflows reflect how your state's Medicaid program, portals, and renewal rules actually work. • Transparent results: A clear attribution method and regular business reviews tied to members retained, members recovered, and revenue protected. • Secure and compliant: HIPAA-compliant, SOC 2 certified, BAA provided, with patient opt-out at every touchpoint. • Dedicated support: A named customer success partner who knows your health centers, from kickoff through renewal. WHO USES POINTCARE • CEOs and Executive Directors use Pointcare to protect the mission and keep patients connected to their health center. • CFOs and Finance Directors use Pointcare to protect Medicaid revenue, improve payer mix, and find retroactive billing. • COOs and Operations Directors use Pointcare to reduce manual workload and prepare for H.R. 1 volume. • Enrollment, Eligibility, and Member Services teams use Pointcare to replace reactive worklists with prioritized, automated workflows. • Compliance and Privacy Officers use Pointcare because it was built around HIPAA and patient trust from the start. • Primary Care Associations and consortiums use Pointcare to give every member health center, large or small, rural or urban, the same coverage management tools. WHY POINTCARE Pointcare has focused on one thing for more than 13 years: keeping safety-net patients covered. It isn't an analytics dashboard with an enrollment feature added on, and it isn't an enrollment form. It's a single coverage management platform with one data model that predicts, prevents, and recovers coverage gaps and learns from every coverage cycle it processes. As Medicaid rules keep changing, health centers need a system that adapts with them and a partner that shares their mission. Continuity of coverage is continuity of care. Stay covered. Stay cared for.