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 |
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PECOS application |
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CMS-855A |
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CMS-588 EFT |
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- 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
- Health Resources and Services Administration | HRSA - A Notice of Award (NoA) for federal grant money is commonly submitted.
- 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
Application Type | Processing Time |
---|---|
PECOS | On average, it can take 15 to 50 calendar days before application is sent to state and CMS for approval |
Paper | On average, it can take 30 to 65 calendar days before application is sent to state and CMS for approval |
Note:
- Once Noridian has completed the reviewal of the application, a Recommendation for Approval Letter is sent to the State Agency and CMS. There is no set timeframe for their review.
- Additional days after State and CMS approval Noridian will have additional days to finalize enrollment records.