Common use of FQHCs and RHCs Services Clause in Contracts

FQHCs and RHCs Services. Effective for dates of services beginning January 1, 2015 and thereafter, the MCO shall adjudicate Medicaid claims as a zero pay for services provided to the MCO’s Enrollees at a FQHC or RHC. The MCO will forward these adjudicated claims to the STATE within seven (7) calendar days of adjudication and will submit the claims in a weekly file submission. Claims in which Medicare or TPL is primary and the claim is paid in full should not to be included in the submission. The STATE will adjudicate the claims for resolution for the FQHC or RHC and provide the MCO with a Remittance Advice for the processed claims. The MCO will be required to submit a separate encounter claim for these transactions. The STATE will provide technical specifications for this process and will post the document on the managed care webpage. The MCO and STATE will continue to collaborate through a workgroup to monitor the implementation progress of this section and address concerns about the process. The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015. The MCO shall provide the data report in a format specified by the STATE within thirty (30) days of the end of each quarter. The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently designated FQHCs or RHCs. If a new list is not provided, the MCO shall use the prior monthly listing. Any new FQHC/RHC Providers identified after the third of the month will be added to the following monthly MCO report.

FQHCs and RHCs Services. Effective for dates of services beginning January 1, 2015 and thereafter, the MCO shall adjudicate Medicaid claims as a zero pay for services provided to the MCO’s Enrollees at a FQHC or RHC. . (A) The MCO will forward these adjudicated claims to the STATE within seven (7) calendar days of adjudication and will submit the claims in a weekly file submission. Claims in which Medicare or TPL is primary and the claim is paid in full should not to be included in the submission. . (B) The STATE will adjudicate the claims for resolution for the FQHC or RHC and provide the MCO with a Remittance Advice for the processed claims. The MCO will be required to submit a separate encounter claim for these transactions. The STATE will provide technical specifications for this process and will post the document on the managed care webpage. The MCO and STATE will continue to collaborate through a workgroup to monitor the implementation progress of this section and address concerns about the process. . (C) The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015. The MCO shall provide the data report in a format specified by the STATE within thirty (30) days of the end of each quarter. . (D) The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently designated FQHCs or RHCs. If a new list is not provided, the MCO shall use the prior monthly listing. Any new FQHC/RHC Providers identified after the third of the month will be added to the following monthly MCO report. (E) For MinnesotaCare adult enrollees without children, the MCO shall resume processing and paying FQHC/RHC claims for dates of service July 1, 2015 and thereafter. (Remainder of page intentionally left blank)

FQHCs and RHCs Services. Effective for dates of services beginning January 1, 2015 and thereafter, the MCO shall adjudicate Medicaid claims as a zero pay for services provided to the MCO’s Enrollees at a FQHC or RHC. . (A) The MCO will forward these adjudicated claims to the STATE within seven (7) calendar days of adjudication and will submit the claims in a weekly file submission. Claims in which Medicare or TPL is primary and the claim is paid in full should not to be included in the submission. . (B) The STATE will adjudicate the claims for resolution for the FQHC or RHC and provide the MCO with a Remittance Advice for the processed claims. The MCO will be required to submit a separate encounter claim for these transactions. The STATE will provide technical specifications for this process and will post the document on the managed care webpage. The MCO and STATE will continue to collaborate through a workgroup to monitor the implementation progress of this section and address concerns about the process. . (C) The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015. The MCO shall provide the data report in a format specified by the STATE within thirty (30) days of the end of each quarter. . (D) The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently designated FQHCs or RHCs. If a new list is not provided, the MCO shall use the prior monthly listing. Any new FQHC/RHC Providers identified after the third of the month will be added to the following monthly MCO report. (E) For MinnesotaCare adult enrollees without children, the MCO shall resume processing and paying FQHC/RHC claims for dates of service July 1, 2015 and thereafter.‌ (Remainder of page intentionally left blank)

FQHCs and RHCs Services. Effective for dates of services beginning January 1, 2015 and thereafter, the MCO shall adjudicate Medicaid claims as a zero pay for services provided to the MCO’s Enrollees at a FQHC or RHC. RHC.‌ (A) The MCO will forward these adjudicated claims to the STATE within seven (7) calendar days of adjudication and will submit the claims in a weekly file submission. Claims in which Medicare or TPL is primary and the claim is paid in full should not to be included in the submission. . (B) The STATE will adjudicate the claims for resolution for the FQHC or RHC and provide the MCO with a Remittance Advice for the processed claims. The MCO will be required to submit a separate encounter claim for these transactions. The STATE will provide technical specifications for this process and will post the document on the managed care webpage. The MCO and STATE will continue to collaborate through a workgroup to monitor the implementation progress of this section and address concerns about the process. . (C) The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015. The MCO shall provide the data report in a format specified by the STATE within thirty (30) days of the end of each quarter. . (D) The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently designated FQHCs or RHCs. If a new list is not provided, the MCO shall use the prior monthly listing. Any new FQHC/RHC Providers identified after the third of the month will be added to the following monthly MCO report.

FQHCs and RHCs Services. Effective for dates of services beginning January 1, 2015 and thereafter, the MCO shall adjudicate Medicaid claims as a zero pay for services provided to the MCO’s Enrollees at a FQHC or RHC. The MCO will forward these adjudicated claims to the STATE within seven (7) calendar days of adjudication and will submit the claims in a weekly file submission. Claims in which Medicare or TPL is primary and the claim is paid in full should not to be included in the submission. submission The STATE will adjudicate the claims claim for resolution for the FQHC or RHC and provide the MCO with a Remittance Advice for the processed claims. The MCO will be required to submit a separate encounter claim for these transactions. The STATE will provide technical specifications for this process and will post the document on the managed care webpage. The MCO and STATE will continue to collaborate through a workgroup to monitor the implementation progress of this section and address concerns about the process. The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015. The MCO shall provide the data report in a format specified by the STATE within thirty (30) days of the end of each quarter. The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently designated FQHCs or RHCs. If a new list is not provided, the MCO shall use the prior monthly listing. Any new FQHC/RHC Providers identified after the third of the month will be added to the following monthly MCO report.

FQHCs and RHCs Services. Effective for dates of services beginning January 1, 2015 and thereafter, the MCO shall adjudicate Medicaid claims as a zero pay for services provided to the MCO’s Enrollees at a FQHC or RHC. . (A) The MCO will forward these adjudicated claims to the STATE within seven (7) calendar days of adjudication and will submit the claims in a weekly file submission. Claims in which Medicare or TPL is primary and the claim is paid in full should not to be included in the submission. . (B) The STATE will adjudicate the claims for resolution for the FQHC or RHC and provide the MCO with a Remittance Advice for the processed claims. The MCO will be required to submit a separate encounter claim for these transactions. The STATE will provide technical specifications for this process and will post the document on the managed care webpage. The MCO and STATE will continue to collaborate through a workgroup to monitor the implementation progress of this section and address concerns about the process. The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015. The MCO shall provide the data report in a format specified by the STATE within thirty . (30C) days of the end of each quarter. The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently designated FQHCs or RHCs. If a new list is not provided, the MCO shall use the prior monthly listing. Any new FQHC/RHC Providers identified after the third of the month will be added to the following monthly MCO report.report.‌ (D) For MinnesotaCare adult enrollees without children, the MCO shall resume processing and paying FQHC/RHC claims for dates of service July 1, 2015 and thereafter. (Remainder of page intentionally left blank)

FQHCs and RHCs Services. Effective for dates of services beginning January 1, 2015 and thereafter, the MCO shall adjudicate Medicaid claims as a zero pay for services provided to the MCO’s Enrollees at a FQHC or RHC. . (A) The MCO will forward these adjudicated claims to the STATE within seven (7) calendar days of adjudication and will submit the claims in a weekly file submission. Claims in which Medicare or TPL is primary and the claim is paid in full should not to be included in the submission. . (B) The STATE will adjudicate the claims for resolution for the FQHC or RHC and provide the MCO with a Remittance Advice for the processed claims. The MCO will be required to submit a separate encounter claim for these transactions. The STATE will provide technical specifications for this process and will post the document on the managed care webpage. The MCO and STATE will continue to collaborate through a workgroup to monitor the implementation progress of this section and address concerns about the process. . (C) The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015. The MCO shall provide the data report in a format specified by the STATE within thirty (30) days of the end of each quarter. . (D) The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently designated FQHCs or RHCs. If a new list is not provided, the MCO shall use the prior monthly listing. Any new FQHC/RHC Providers identified after the third of the month will be added to the following monthly MCO report.

FQHCs and RHCs Services. Effective for dates of services beginning January 1, 2015 and thereafter, the MCO shall adjudicate Medicaid claims as a zero pay for services provided to the MCO’s Enrollees at a FQHC or RHC. RHC.‌ The MCO will forward these adjudicated claims to the STATE within seven (7) calendar days of adjudication and will submit the claims in a weekly file submission. Claims in which Medicare or TPL is primary and the claim is paid in full should not to be included in the submission. The STATE will adjudicate the claims for resolution for the FQHC or RHC and provide the MCO with a Remittance Advice for the processed claims. The MCO will be required to submit a separate encounter claim for these transactions. The STATE will provide technical specifications for this process and will post the document on the managed care webpage. The MCO and STATE will continue to collaborate through a workgroup to monitor the implementation progress of this section and address concerns about the process. The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015. The MCO shall provide the data report in a format specified by the STATE within thirty (30) days of the end of each quarter. quarter.‌ The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently designated FQHCs or RHCs. If a new list is not provided, the MCO shall use the prior monthly listing. Any new FQHC/RHC Providers identified after the third of the month will be added to the following monthly MCO report.

FQHCs and RHCs Services. Effective for dates of services beginning January 1, 2015 and thereafter, the MCO shall adjudicate Medicaid claims as a zero pay for services provided to the MCO’s Enrollees at a FQHC or RHC. RHC.‌ The MCO will forward these adjudicated claims to the STATE within seven (7) calendar days of adjudication and will submit the claims in a weekly file submission. Claims in which Medicare or TPL is primary and the claim is paid in full should not to be included in the submission. submission The STATE will adjudicate the claims claim for resolution for the FQHC or RHC and provide the MCO with a Remittance Advice for the processed claims. The MCO will be required to submit a separate encounter claim for these transactions. The STATE will provide technical specifications for this process and will post the document on the managed care webpage. The MCO and STATE will continue to collaborate through a workgroup to monitor the implementation progress of this section and address concerns about the process. The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015. The MCO shall provide the data report in a format specified by the STATE within thirty (30) days of the end of each quarter. The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently designated FQHCs or RHCs. If a new list is not provided, the MCO shall use the prior monthly listing. Any new FQHC/RHC Providers identified after the third of the month will be added to the following monthly MCO report.

FQHCs and RHCs Services. Effective for dates of services beginning January 1, 2015 and thereafter, the MCO shall adjudicate Medicaid claims as a zero pay for services provided to the MCO’s Enrollees at a FQHC or RHC. . (A) The MCO will forward these adjudicated claims to the STATE within seven (7) calendar days of adjudication and will submit the claims in a weekly file submission. Claims in which Medicare or TPL is primary and the claim is paid in full should not to be included in the submission. (B) The STATE will adjudicate the claims claim for resolution for the FQHC or RHC and provide the MCO with a Remittance Advice for the processed claims. The MCO will be required to submit a separate encounter claim for these transactions. The STATE will provide technical specifications for this process and will post the document on the managed care webpage. The MCO and STATE will continue to collaborate through a workgroup to monitor the implementation progress of this section and address concerns about the process. . (C) The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015. The MCO shall provide the data report in a format specified by the STATE within thirty (30) days of the end of each quarter. . (D) The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently designated FQHCs or RHCs. If a new list is not provided, the MCO shall use the prior monthly listing. Any new FQHC/RHC Providers identified after the third of the month will be added to the following monthly MCO report.

FQHCs and RHCs Services. Effective for dates of services beginning January 1, 2015 and thereafter, the MCO shall adjudicate Medicaid claims as a zero pay for services provided to the MCO’s Enrollees at a FQHC or RHC. RHC.‌ The MCO will forward these adjudicated claims to the STATE within seven (7) calendar days of adjudication and will submit the claims in a weekly file submission. Claims in which Medicare or TPL is primary and the claim is paid in full should not to be included in the submission. submission The STATE will adjudicate the claims claim for resolution for the FQHC or RHC and provide the MCO with a Remittance Advice for the processed claims. The MCO will be required to submit a separate encounter claim for these transactions. The STATE will provide technical specifications for this process and will post the document on the managed care webpage. The MCO and STATE will continue to collaborate through a workgroup to monitor the implementation progress of this section and address concerns about the process. The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015. The MCO shall provide the data report in a format specified by the STATE within thirty (30) days of the end of each quarter. quarter.‌ The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently designated FQHCs or RHCs. If a new list is not provided, the MCO shall use the prior monthly listing. Any new FQHC/RHC Providers identified after the third of the month will be added to the following monthly MCO report.