Federally Qualified Health Center (FQHC)

Information is found in CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 15 Section 4.1.4 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
  • "Institutional Provider" (e.g., Hospital, Skilled Nursing Facility, Hospice, Home Health Agency)
  • Complete questionnaire to ensure correct applications (CMS-855A and CMS 588-EFT) populate.
CMS-855A
  • Complete all form sections
  • Attach all supporting documentation such as IRS documents
  • List all directors, board members, and contracted or W-2 managing employee
  • Visit the Application Fee webpage to access CMS link to pay application fee
CMS-588 EFT
  • Submit completed CMS-588 EFT and voided check/bank letter. EIN required to be on application in Tax Identification Number (TIN) field

 

  • 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
  • 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. Below are the time frames in which Noridian has to review the application
Application Type Processing Time
PECOS On average, it can take 45 calendar days before application is sent to the state and CMS for approval
Paper On average, it can take 60 calendar days before application is sent to the state and CMS for approval

 

  • After the Regional Office has completed their reviewal, a tie-in notice is sent to Noridian. After receiving the tie-in Noridian will have the following time-frames to complete the application.
    • If a site visit is needed, Noridian will have 45 days to complete the application
    • If a site visit is not needed, Noridian will have 21 days to complete the application

 

Last Updated Sep 04, 2019