NACHC + Pointcare: A Game-Changing Partnership for CHCs Read the Announcement »
The Pointcare Coverage Intelligence Engine™
Billions of signals.
One next step, per member.
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.
THE WINDOW NOBODY'S WATCHING
Coverage doesn't wait for the next visit
A member's coverage changes at the state agency, not the front desk. By the time a claim denies, they may have been uninsured for weeks. Most members don't call to report a lapse. They just stop showing up covered.
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Redeterminations, work requirement checks, and address verifications all happen off-site, on the state's timeline, not the clinic's.
- A front-desk eligibility check only catches what's already gone wrong.
- Every month that passes without a check is a month a lapse can go unnoticed.
Coverage Intelligence™ exists to close that window, for every member, every month, not just the ones who happen to have an appointment.
FROM NOISE TO SIGNAL
One redet date. One next step. Per member.
Any single feed, on its own, is mostly noise: a status code here, a plan change there. The Coverage Intelligence Engine reads all of them together and produces exactly two things a care team can act on.
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Know exactly when a member's redetermination is due, before they do.
- See the specific reason a member is at risk: procedural denial, income change, work requirement, or an address mismatch.
- Get the one next action to take: which application to route, which document is missing, which channel reaches them.
- Track every member's coverage position in one place, not spread across a payer portal, an EHR, and a spreadsheet.
"The data from any single source has a lot of noise. It's the Coverage Intelligence™ Engine that turns that noise into signal: the redet date, and the next logical step to get a patient back to coverage." - Coverage Intelligence in one sentence
For Providers
Automate outreach and manual processes. Protect your bottom line maintaining high insured-patient visit rates.
For Individuals
Get covered and stay covered with stress-free enrollment. Easily manage your household's coverage and access help 24/7.
WHAT FEEDS THE ENGINE
Four signal sources. One continuous read.
Coverage checks
Current and historical eligibility checks across Medicaid, Medicare, and the Marketplace, run every month against every member in the panel, not just the ones with an appointment on the books.
Aid code & eligibility changes
The specific state-level status codes and eligibility changes that precede a lapse, read the moment they post, not at the next renewal cycle.
Plan & MCO changes
Managed care reassignments, plan switches, and payer-level movement that change how and where a claim gets paid, tracked as they happen.
Your own data
Anything your clinic provides: EHR records, enrollment staff notes, prior outreach history. This is what tunes the engine to your specific members, not a generic industry model.
FROM BILLIONS OF SIGNALS TO ONE ACTION
How the engine turns noise into signal
Capture
Every coverage check, every aid code change, every plan and MCO update pulled in continuously, not batched once a quarter.
Correlate
Matched against your own member data, so the read is tuned to your specific population, not a generic industry average.
Compute
Thirteen years of pattern recognition turn the combined feed into two things: a redetermination date, and a lapse risk score.
Convert
The engine attaches the next logical step: the specific action that gets that member back to coverage, or keeps them there.
WHAT THE ENGINE DELIVERS
Signals that get acted on, on the same day
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Redetermination calendar — every member's renewal date, plotted before it's due.
- Lapse risk scores — who's likely to lose coverage, and why, 30 to 60 days out.
- Next-best-action — the specific step (submit, escalate, contact) for each at-risk member.
- Automated outreach — multi-channel, multi-language outreach triggered the moment risk is detected.
- Household view — risk and status rolled up across every covered member in a family.
BILLIONS OF SIGNALS. EVERY MONTH.
3M+
Patients under coverage management
1B+
Coverage signals continuously captured
43M+
Coverage checks processed
13yrs
Of continuous pattern learning
1,700+
Public and subsidized programs read
Demo
See Pointcare in Action
In this demo, you'll see Pointcare in action and learn:
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How we support the identification of redetermination dates, find lapses, re-engage patients, and keep coverage on track — automatically.
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How to transform your workflow from reactive to proactive.
- Why AltaMed, CVHS, and 120+ other health centers manage 2.9M+ patients with Pointcare.