Federally Qualified Health Center (FQHC) - JE Part A

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.

• Billing for FQHC
• Application Requirements
• Application Time Frame

Billing for FQHC

• For more information regarding billing, go to the billing portion of the website.

Application Requirements

• 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
• 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

Note:

1. 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.
2. Additional days after State and CMS approval Noridian will have additional days to finalize enrollment records.