Modification to Federally Qualified Healthcare Center (FQHC) Claims Submission Criteria

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Effective March 15, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will implement changes to Federally Qualified Healthcare Centers (FQHCs) enrollment and claims submission criteria. FQHC’s will be required to enroll all individual chiropractors, podiatrists, dietitians, ophthalmologists, and optometrists that are providing/rendering service to Healthy Connections Medicaid members through the FQHC. To meet the revised claims submission criteria requirements, all rendering providers must be linked to each FQHC group/pay to provider number that they may render services for. 

To assist SCDHHS with identifying providers that need to be enrolled and linked to existing group/pay to provider numbers, complete the attached form and fax the completed form to Provider Enrollment at (803) 870-9022 by April 15, 2015.  A separate form is required for each FQHC group number.

SCDHHS will identify all individual providers currently enrolled with Healthy Connections Medicaid and use the completed forms to link individual rendering providers to the appropriate FQHC group/pay to provider number.  If an individual rendering provider is not currently enrolled as a Healthy Connections Medicaid provider, the FQHC will be notified and guidance will be provided on completing and submitting an online provider enrollment application for the individual/rendering provider. 

The National Provider Identifier (NPI) of the referring and rendering provider must be included on the Medicaid claim form for payment.  The referring provider is the individual who sent/directed the patient for care.  The rendering provider is the individual providing care to the patient.  Please see below for the reference and guideline tool for hard copy and electronic claim submissions.

 

Claim Form

Field Number

Field Name

Special Note

CMS-1500 (02/12)

17

Name of Referring Provider or Other Source

Enter the two-byte qualifier to the left of the vertical, dotted line. Valid qualifiers are DN=Referring; DK=Ordering; DQ=Supervising. Then, enter the name of referring, ordering or supervising provider. 

 

17B

NPI

Enter the NPI of referring, ordering or supervising provider.

CMS-1500

24J Shaded

Rendering Provider ID

Enter the rendering provider’s taxonomy code.

CMS-1500

24J Un-shaded

Rendering Provider ID

Enter the rendering provider’s NPI.

837P

2310A

Referring Provider

Enter the NPI of referring or ordering provider.

837P

2310B

Rendering Provider’s Taxonomy

Enter the rendering provider’s taxonomy code.

837P

2310B

Rendering Provider NPI

Enter the rendering provider’s NPI.

 

 

Providers may refer to the South Carolina Companion Guide for additional information regarding placement of the referring NPI and taxonomy code on electronic claims.  The Companion Guide is located on the SCDHHS website at https://www.scdhhs.gov/resource/sc-medicaid-companion-guides

Please refer any questions regarding this bulletin to the SCDHHS Provider Service Center at (888) 289-0709.  Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

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