FQHC notification

Date: 05/02/23

Ambetter from WellCare of New Jersey has historically allowed Federally Qualified Health Centers and Rural Health Clinics to submit claims on the CMS 1450 and CMS 1500 forms using CPT codes. To align with CMS guidelines, effective June 1, 2023, Ambetter from WellCare of New Jersey  will only accept claims with RHC / FQHC specific encounter and revenue codes on a UB-04/CMS 1450 form or in the 837I electronic file format when billing encounters. This claim format would be the same as your Medicare billing format. Please refer to the CMS Medicare Claims Processing Manual, Chapter 9 for RHC/FQHC billing and payment requirements.  

https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c09.pdf

Please make appropriate changes in your EHR before June 1, 2023, to avoid an interruption in payments. FQHC / RHC specific encounter and revenues codes submitted on the CMS 1500 form or 837P electronic file format will deny beginning June 1, 2023.

We thank you for your commitment to the care and wellbeing of our members and to the communities we serve. Should you have any questions or concerns about this notification, please contact us at Provider Services 1-844-606-1926.