FQHCs and RHCs Clause Samples
The 'FQHCs and RHCs' clause defines the specific terms and conditions that apply to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) within a contract or agreement. It typically outlines how services provided by these entities are billed, reimbursed, or subject to special regulatory requirements, such as enhanced payment rates or reporting obligations. For example, the clause may specify that claims from FQHCs and RHCs are processed differently than those from other providers, or that certain compliance standards must be met. The core function of this clause is to ensure that the unique legal and financial considerations for FQHCs and RHCs are clearly addressed, reducing ambiguity and supporting compliance with federal and state regulations.
FQHCs and RHCs. The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015 in accordance with section 3.7(C) below. In the event that a FQHC/RHC contacts the MCO or the STATE regarding payments made to the FQHC/RHC prior to January 1, 2015, but not included in any submitted report, the MCO shall review, and if appropriate, must submit the missing data. Within eight (8) business days of receipt of this report, the STATE shall provide the MCO a return file that contains incorrect data lines that cannot be read by the system and loaded. The MCO must review the data lines and correct appropriately. Corrected data lines must be resubmitted within thirty (30) days, and shall be reported separately as a corrected file. The MCO shall not resubmit data already submitted and accepted.
FQHCs and RHCs. The MCO shall provide to the STATE a quarterly report for the first quarter of Contract Year 2010, due no later than thirty (30) days following the end of the quarter. The report must identify MCO payments made to FQHCs and RHCs for all programs covered under this Contract. As of April 1st of Contract Year, reports shall be submitted monthly, with the first monthly report due no later than May 31, 2010.
(1) The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently qualified to be 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.
(2) Pursuant to the State’s specifications in the document entitled “FQHC/RHC Payment Data Report,” MCO reports will be submitted no later than the last day of the following month.
(3) Within eight (8) business days of receipt of this report, the STATE shall provide the MCO a return file that contains incorrect data lines that cannot be read by the system and loaded. The MCO must review the data lines and correct appropriately. Corrected data lines must be re-submitted with the next monthly report, and shall be reported separately as a corrected file. The MCO shall not re-submit data already submitted and accepted.
(4) In the event that a FQHC/RHC contacts the MCO regarding payments made to the FQHC/RHC during the previous month, but not included in the submitted report, the MCO shall review, and if appropriate, must submit the missing data on the following monthly report.
FQHCs and RHCs. The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015 in accordance with section 3.8(C) below. In the event that a FQHC/RHC contacts the MCO or the STATE regarding payments made to the FQHC/RHC prior to January 1, 2015, but not included in any submitted report, the MCO shall review, and if appropriate, must submit the missing data. Within eight (8) business days of receipt of this report, the STATE shall provide the MCO a return file that contains incorrect data lines that cannot be read by the system and loaded. The MCO must review the data lines and correct appropriately. Corrected data lines must be resubmitted within thirty (30) days, and shall be reported separately as a corrected file. The MCO shall not resubmit data already submitted and accepted. Payment for ad hoc Reporting. The STATE may require reimbursement at standard rates for ad hoc reports requested of the STATE. For the purposes of this section, “standard rates” means those listed in the STATE policy “DHS Policies and Procedures for Handling Protected Information: 2.60 Data Requests and Copy Costs” available at ▇▇▇▇://▇▇▇.▇▇▇.▇▇▇▇▇.▇▇.▇▇/id_017855. Reporting on MSHO Stakeholder Group. For the MCO’s local or regional stakeholder group (as required in section 7.4.4) the MCO will submit to the STATE twice per Contract Year, on or before June 15th and December 15th, documentation in the form of stakeholder meeting agendas and meeting minutes that demonstrate the MCO response to significant concerns raised by stakeholder group participants. The STATE shall provide the MCO with an electronic listing of all enrolled MHCP Providers and their NPI or UMPI numbers on a monthly basis. The MCO must update the Provider identification numbers by submitting, for Providers who are new to the MCO and do not already have a STATE Provider number (UMPI) or NPI, current complete demographic information about the Provider, on a form approved by the STATE. The MCO shall not require Providers to enroll as an MHCP FFS Provider. If a Provider will only be serving MCO Enrollees, the MCO shall follow the process established by the STATE for MCO-only Providers. Payment Review Information. The MCO shall identify aggregate payment information for specific Provider categories and assess the information as to how it compares to FFS payment information. As part of the assessment the MCO will also be expected to provide an explanation of the basis for how the Prov...
FQHCs and RHCs. In the event that a FQHC/RHC contacts the MCO or the STATE regarding payments made to the FQHC/RHC prior to January 1, 2015, but not included in any submitted report, the MCO shall review, and if appropriate, must submit the missing data.
(1) Within eight (8) business days of receipt of this report, the STATE shall provide the MCO a return file that contains incorrect data lines that cannot be read by the system and loaded. The MCO must review the data lines and correct appropriately. Corrected data lines must be resubmitted within thirty (30) days, and shall be reported separately as a corrected file. The MCO shall not resubmit data already submitted and accepted.