Summary
Tribal FQHCs can choose one of three reimbursement options: an IHS-AIR alternative payment methodology that does not require cost reports, the Alaska Medicaid PPS FQHC rate, or a facility-specific cost-based rate. A Tribal FQHC does not have to enroll in Medicare, and the four walls restriction on clinic services does not apply to FQHC services. CMS extended the grace period for offsite clinic services to February 11, 2025, and a Tribal FQHC may provide off-site services, including at temporary locations such as a health fair, school or fish camp.
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What to do
Action · 6 steps
01Tribal clinics that want Tribal FQHC status should submit the Tribal FQHC Conversion/Election form, which is available online through the fiscal agent.
02Providers should hold billing from the date they decide to convert until the conversion is approved, because an existing Tribal Clinic enrollment cannot be backdated and claims will not be reprocessed if billed during that period.
03Each permanent site must enroll separately, and a Tribal FQHC may not operate multiple permanent sites under the same provider enrollment.
04Labor and delivery services are billed through a Health Professional Group at the fee-for-service rate, and pre- and post-natal services are submitted with the appropriate E/M code on the day the service was furnished.
05Behavioral health codes billed by a Tribal FQHC are limited to those in the billing manual, and a facility that needs other behavioral health services must enroll separately as a Community Behavioral Health Center.
06Alaska Medicaid covers these behavioral health CPT codes under FQHC/RHC services, effective January 1, 2023: 90791, 90792, 90832, 90834, 90837, 90839, 90847, 90849, 90853, 96156, 96158, 96159, 96164, 96165, 96167 and 96168.
Codes mentioned
90791907929083290834908379083990847908499085396156961589615996164961659616796168
Original notice
Tribal FQHC FAQs Updated
extranet-sp.dhss.alaska.gov · Always check the source before changing claims.