FQHC AND RHC PAYMENT METHODOLOGY CHANGE

Effective January 1, 2015, AHCCCS and its contracted Managed Care Organizations (MCOs) will begin paying the all-inclusive per visit PPS rate on a per claim basis, replacing the current method of reimbursing claims by the capped fee-for-service fee schedule and annually reconciling to the PPS rate. The method for calculating the all-inclusive per visit PPS rates will not change.

AHCCCS will continue to perform annual reimbursement reconciliations. Additionally, AHCCCS anticipates that quarterly supplemental payments will continue, though in amounts appropriate to the expectation that the MCOs will, in most cases, be paying the PPS rate. MCOs may continue to establish sub-capitated reimbursement arrangements.

All questions related to FQHC/RHC reimbursements should be directed to Victoria Burns at (602) 417-4049 or by email at Victoria.Burns@azahcccs.gov.

 

Provider Registration for FQHCs, FQHC Look-Alikes, and RHCs

AHCCCS has established a unique provider type for FQHCs and FQHC Look-Alikes (C2) and a unique provider type for RHCs (29). AHCCCS is requiring that all FQHCs, FQHC Look-Alikes, and RHCs re-register under the applicable provider types. AHCCCS is also requiring that FQHCs, FQHC Look-Alikes, and RHCs obtain a unique NPI, not already associated with another active AHCCCS provider ID, for each clinic covered by the CMS FQHC, FQHC Look-Alike, or RHC designation. The new NPIs will be used for claim submissions beginning with dates of service on and after January 1, 2015.

For questions related to provider registration, please contact Veronica Valenzuela at (602) 417-7516 or by email at Veronica.Valenzuela@azahcccs.gov.

 

Recent Communication


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