Medicaid FQHC/THC/RHC updates

Effective August 1, 2017, Medicaid made changes to claim processing and reimbursement for services billed by Federally Qualified Health Centers (FQHC), Tribal Health Centers (THC) and Rural Health Centers (RHC), then delayed the changes, then instated them. Here is our progress on implementing the required changes.

See Medicaid FQHC/RHC/THC billing details.

Changes progress as of Sept. 19, 2018

Final update: Reprocessing affected claims will be completed by Sept. 28.

If you have unresolved issues after Oct. 12, reach out to us by using the Claims Inquiry tool, opening the claim and clicking the Email Provider Services link. We'll investigate the issue.

Issue Status Est. date in production Claims reprocessed
Update FQHC/RHC/THC fee schedules to contain only the codes that are payable Complete
The state has determined that 58356 is a payable code for THC. It will be set to reimburse at $0 until the SOM adds a rate to the fee schedule
Update 7/30: SOM published the fee schedule rate of $1,048.54 for DOS July 2018 and after.
07/02/2018 NA
Validate all appropriate J-codes are set up for billing with the U6 modifier Complete 06/08/2018 NA
MIHP – validate setup is correct since some payers are getting rejections and others are not Complete
Update 07/10: Identified an additional 1200 claims for reprocessing. If you continue to experience issues, report them with "Config log 23300."
Update 09/19: Identified an additional 384 claims for reprocessing under "Config log 25100." Completed 09/19/2018.
06/15/2018 7/25/2018
Update front end edit 5212 to account for MIHP claims Complete 06/14/2018 NA
Update front end edit to allow for UB claims without Clinic-PPS Visit Code and Clinic Qualifying Visit combinations in certain circumstances Complete 06/14/2018 NA
Validate we have an 8000 number for every facility on the state list that has submitted claims in the last year In progress 07/20/2018 NA
Validate we have the correct Agreement ID attached to these facilities
In progress 07/20/2018 NA
Remove the FQHC agreements on any facilities not on the state list and reprocess claims Complete
Inquiry 1807031491366 has been submitted for reprocessing 8 claims
06/29/2018 08/08/2018
Remove the RHC/THC agreements on any facilities not on the state list and reprocess claims Complete 07/10/2018   NA
OB visits, RHC/THC – correct system set up to process off fee schedule and reprocess claims Complete
Identified 112 claims for reprocessing. If you continue to experience issues, report them with "Config log 24880."
07/10/2018 09/14/2018
OB visits, FQHC – correct system set up to process off fee schedule and reprocess claims Complete
Inquiry has been submitted to reprocess 9 claims
07/02/2018  07/18/2018
Routine vision - payable when billed appropriately. Correct system set up and reprocess claims Complete
Identified approx. 3600 claims for reprocessing. If you experience errors, report them with "Config log 24060."
07/20/2018 09/28/2018
Behavioral health, RHC/THC - correct system set up since not all are processing multiple rates when billed Complete
Identified approx. 1600 claims for reprocessing. If you experience issues, report them with "Config log 24900."
07/10/2018 09/21/2018
Behavioral health, FQHC - correct system set up since not all are processing multiple rates when billed Complete
Identified approx. 6500 claims for reprocessing. 
Update 09/2018: Identified an additional 1664 claims for reprocessing. If you experience issues, report them with "Config log24700 (completed 09/10/2018) and 24900 (completed 09/21/2018)."
07/02/2018 08/31/2018
J or Clinic-excluded high-cost codes only, RHC/THC - identify incorrect rejections and reprocess claims Complete
07/10/2018 NA
J or Clinic-excluded high-cost codes only, FQHC - identify incorrect rejections and reprocess claims Complete
Identified approx. 950 claims for reprocessing.
If you experience errors, report them with "Config log 23480." 
07/02/2018 07/19/2018
Validate remittance advice for RHC/THC is displaying payments correctly for electronic posting Complete 07/10/2018  NA
Validate remittance advice for FQHC is displaying payments correctly for electronic posting Complete 07/02/2018  NA