Medicare AdvantageAdministrativeMedium impact
MAPAP113 - Billing Requirements for Rural Health Centers (RHCs) - Revised exclusions added
Blue Cross of Idaho·ID · Family Medicine, Internal Medicine, General Practice +1 more·Reimbursement
Effective date
Aug 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho revised billing requirements for Rural Health Centers (RHCs) under Medicare Advantage plans, removing MMCP/IMP language from previous policy versions. RHCs must continue using specific Type of Bill 71X with designated revenue codes and CPT/HCPCS codes for qualifying visits under the CMS prospective payment system.
Action Required
Immediately: RHC billing teams must ensure all Medicare Advantage claims use Type of Bill 71X with appropriate revenue codes (0521, 0522, 0523, 0524, 0525, 0527, 0900) for qualifying visits. Update billing system documentation to remove any references to MMCP/IMP language. Verify one service line per encounter with correct CPT/HCPCS and revenue code pairing. Claims without proper TOB and revenue codes will be denied.