Effective 7/1: FQHC and RHC must bill Medicaid claims on UB forms

06-16-2017

The date of this change has been updated from May 1 to July 1, 2017.

Effective July 1, 2017, all Medicaid claims billed by Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC) and Tribal Health Centers (THC) must be billed on a Uniform Billing (UB) claim form instead of a HCFA 1500 form.

Specifically, these providers must bill:

  • Electronic claims using the ASC X12N 837 5010 institutional format
  • Paper claims on the National Uniform Billing Code (NUBC) claim form.

This change is mandatory from CMS, and is in effect for all plans. Using the institutional format will align Medicaid with Medicare billing and allow for each clinic's respective encounter rate to be paid after successful adjudication for fee-for-service (FFS) claims. Currently, a provider must bill Medicare on the institutional format and then resubmit the claim to Medicaid on the professional format, and this change will streamline the billing process.

Questions?

For additional information, see the MDHHS bulletin.