CoverageGuard IQ helps FQHCs identify patients at risk of Medicaid coverage loss, prioritize intervention, and manage redetermination follow-through through a human-reviewed, auditable workflow.
On January 1, 2027, the retroactive eligibility window narrows from 90 days to 30 days for expansion enrollees and 60 days for everyone else. Every timeline for coverage recovery compresses with it.
Two clocks on one panel — and your staff has to know which patient is on which.
Eligible patients already fall off at redetermination: fragmented eligibility data, stale contacts, inconsistent follow-up, unclear ownership. Batch-cycle approaches will not fit inside the new window.
Retroactive coverage limits per the One Big Beautiful Bill Act (P.L. 119-21), effective for applications submitted on or after January 1, 2027.
Services delivered while a patient is uncovered depend on retroactive coverage to be reimbursed. As that window shortens, more of them fall outside it.
Gaps interrupt care continuity, cut pharmacy access, and push patients to the ED. Eligible-but-uncovered patients absorb the most harm.
CoverageGuard IQ closes the full recertification loop:
It reconciles conflicting eligibility signals into one confidence-scored coverage state, then drives each at-risk patient through outreach, document collection, submission as authorized representative, and determination tracking — human-by-exception review, full audit trail.
Interactive Prototype: CoverageGuard IQ uses synthetic demonstration data in its current interactive prototype. It demonstrates the intended workflow and experience. Moving to a controlled pilot requires partner-specific configuration, data agreements, and workflow validation.
CoverageGuard IQ does not make autonomous coverage determinations. All eligibility assessments, outreach decisions, and submissions are reviewed and approved by authorized staff. The AI provides analysis, prioritization, and recommendations — the human decides.
If a controlled evaluation were pursued, it would be structured around a defined scope with clear safeguards and measurable outcomes:
Proposed metrics for evaluation. No outcomes have been validated yet.
Learn more at quantum5d.ai