Are FQHC, RHC and Indian Health Services (IHS) claims required to have medical justification as either a remark on the claim or as an attachment to the claim?
Yes. Medical justification is required as either a remark on the claim or as an attachment to the claim for all excluded optional benefits. The medical justification is in the Remarks field (Box 80) on the UB-04 claim form, or in the NTE segment in the 837 Institutional 4010A1 electronic claim format, or as an attachment to the claim. Optional benefit provided to EPSDT-eligible beneficiaries, Medicare/Medi-Cal “crossover claims” and services rendered by a physician do not require medical justification. Please review the Optional Benefits Exclusion Policy: Additional Billing Information for FQHCs, RHCs and IHS article for detailed information about the medical justification requirements for these facilities.
Related Questions
- Are FQHC, RHC and Indian Health Services (IHS) claims required to have medical justification as either a remark on the claim or as an attachment to the claim?
- Am I able to provide covered services to an AHCCCS American Indian Health Program (formerly IHS/AHCCCS) member?
- Can our members seek services from a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC)?
