Federally Qualified Health Center (FQHC) - JE Part A
Federally Qualified Health Center (FQHC)
Information is found in CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 10 Section 2.1.D and the CMS IOM, Publication 100-07, State Operations Manual, Chapter 2.
- FQHCs furnish services such as those performed by physicians, nurse practitioners, physician assistants, clinical psychologists, and clinical social workers
- This also includes certain preventive services like prenatal services, immunizations, blood pressure checks, hearing screenings and cholesterol screenings
- Health Resources and Services Administration (HRSA) is Part of the Department of Health and Human Services (DHHS) may assist the RO in determining whether a supplier meets FQHC standards, since HRSA maintains a list of suppliers that met certain grant requirements
- To qualify as an FQHC, the facility must, among other things, either furnish services to a medically underserved population or be in a medically underserved area
- Effective date cannot be before the date they submit their 855A in full
On this page, view the below information. (Jump Tos)
Billing for FQHC
- For more information regarding billing, go to the billing portion of the website.
Application Requirements
Application | Tips |
---|---|
PECOS application |
|
CMS-855A |
|
CMS-588 EFT |
|
- If providing Part B services, an 855B will need to be submitted
- Must have the following attachments
- Exhibit 177 - Information provided must match the information reported on the 855A
- Example of HRSA Notice of Award - Most common, they receive Federal Grant money from the Health Resources and Services Administration
- Designation memo (lookalike) - this documentation is needed to be in place showing the exact site address prior to submitting an initial enrollment, Buyer CHOW or a change/revalidation adding a practice location
- Either the HRSA or lookalike must include the LBN and exact (physical) practice location
- If the practice location is listed, they may also submit a form 5 Part B Service Site
- If submitting CHOW, the HRSA needs to be in the name of the buyer prior to the submission of the application
- Either the HRSA or lookalike must include the LBN and exact (physical) practice location
- May only have one (1) practice location per application
- This means if there is an additional practice location that will need to be on file, a separate 855A will need to be submitted for it
Application Time Frame
- Once Noridian has completed the reviewal of the application, a Recommendation for Approval Letter is sent to CMS Survey & Operations Group. Below are the time frames in which Noridian has to review the application
Application Type | Processing Time |
---|---|
PECOS | On average, it can take 15 calendar days before application is sent to the state and CMS for approval |
Paper | On average, it can take 30 calendar days before application is sent to the state and CMS for approval |
- The MAC and CMS Survey & Operations Group (SOG) Locations (formerly CMS Regional Offices and hereafter referenced as “SOG Locations.”) work together on the approval process After the SOG Locations have completed their reviewal, a tie-in notice is sent to Noridian.
- After receiving the tie-in Noridian has 21 days to complete the application.
Last Updated Mon, 24 May 2021 18:58:28 +0000