MedicaidBilling CodesHigh impact
[Virginia] Important update: group billable status for FQHCs and RHCs
Anthem BCBS·VA·Provider Bulletin
Effective date
Apr 1, 2025
We identified it
Jul 2, 2026
Summary
Virginia Medicaid (HealthKeepers/Anthem) requires FQHCs and RHCs to bill at the group level effective April 1, 2025, with specific Place of Service codes and billing taxonomy requirements. FQHCs must use POS 50 with taxonomy 261QF0400X, RHCs must use POS 72 with taxonomy 261QR1300X, and telehealth must use POS 02 or 10. Claims not meeting these requirements will be rejected.
Action Required
By April 1, 2025: Billing team must immediately update billing software to enforce the following requirements for all Virginia Medicaid claims from FQHCs and RHCs: (1) Bill using facility/organization NPI for group-level processing; (2) For FQHCs: require POS 50 and include billing taxonomy 261QF0400X in all claims; (3) For RHCs: require POS 72 and include billing taxonomy 261QR1300X in all claims; (4) For telehealth: require POS 02 or POS 10 with appropriate taxonomy codes. Update claim submission templates and validation rules in the billing system. Train all billing staff on POS code and taxonomy requirements. Verify that ordering, referring, and prescribing providers are enrolled with DMAS as participating care providers. Test claim submissions before April 1, 2025. Claims submitted without correct POS codes and taxonomy will be denied and require resubmission.