MedicaidAdministrativeMedium impact
Supplement 21-04: Tribal FQHC Designation and Billing Guidance
New Mexico Medicaid·NM·Claims & Billing
Effective date
Oct 31, 2021
We identified it
Jun 21, 2026
Summary
New Mexico allows Tribal 638 healthcare facilities to designate as FQHCs, enabling services outside facility walls with OMB rate reimbursement. After October 31, 2021, these services require FQHC conversion and use specific UB-04 billing requirements with revenue codes 0529 and 0919.
Action Required
Before October 31, 2021: Tribal 638 providers wanting FQHC designation must submit written requests to MAD Tribal Liaisons including provider name, Medicaid ID, NPI number, and effective date. Billing team must update systems to use UB-04 forms with type of bill 0771, revenue code 0529 for physical health encounters, and 0919 for behavioral health encounters.