If a member receives both an FFS short term behavioral health service and a medical service on the same day, a FQHC must submit two claims, one with the short term behavioral service using revenue code and one with the medical service using revenue code for two encounter rate payments from Health First Colorado. A visit that includes an FFS short term behavioral health service and other behavioral health services should include all behavioral health services in the visit on the claim billed to Health First Colorado.
Claims and encounters for physician-administered drugs purchased through the B program should include the "UD" code modifier on the P, I and CMS claim formats. For any physician-administered drugs not purchased through the B program, no code modifier is required.
A valid national drug code NDC number must be included on all claims and encounters for physician-administered drugs. The information in the following table provides instructions for completing form locators FL as they appear on the paper UB claim form. The appropriate code values listed in this manual must be used when billing the Health First Colorado.
The UB Certification document located after the Sterilizations, Hysterectomies, and Abortions instructions and in the Provider Services Forms section must be completed and attached to all claims submitted on the paper UB Completed UB paper Health First Colorado claims, including hardcopy Medicare claims, should be mailed to the correct fiscal agent address listed in Appendix A, under the Appendices drop-down section on the Billing Manuals web page.
Do not submit "continuation" claims. Each claim form has a set number of billing lines available for completion. Do not crowd more lines on the form. Billing lines in excess of the designated number are not processed or acknowledged. Claims with more than one page may be submitted through the Provider Web Portal.
For more information on timely filing policy, including the resubmission rules for denied claims, please see the General Provider Information manual available on the Billing Manuals web page under the General Provider Information drop-down menu.
Back to Top. Colorado Official State Web Portal. Abbreviate the state using standard post office abbreviations. Enter the telephone number. Required only if different from FL 1. Optional Enter information that identifies the member or claim in the provider's billing system. Submitted information appears on the Remittance Advice RA. Optional Enter the number assigned to the member to assist in retrieval of medical records. Required Each date of service must be billed on a separate line.
Split an entire month into two claims. This FL must reflect the beginning and ending dates of service listed on the detail dates of service lines. Example: for January 1, Conditional Complete for emergency visits. Exempts outpatient hospital claims from co-payment and PCP referral only if Revenue Code or is present. This is the only benefit service for an undocumented alien. If span billing, emergency services cannot be included in the span bill and must be billed separately from other outpatient services.
Conditional Complete with as many codes necessary to identify conditions related to this bill that may affect payer processing. Condition Codes. Conditional Complete both the code and date of occurrence. Enter the appropriate code and the date on which it occurred.
Occurrence Codes: 1. Benefits Exhausted - Indicate the last date of service that benefits are available and after which payment can be made by payer indicated in FL 50, Line A. Kahlon and Aron C. Thomas and Michael P. Neifach and Otieno B. Porzio and Joshua S. Bryan What a Deal!
Ferrante and Nathaniel M. Porzio and Elizabeth A. Bourne and Daniel J. Ferrante and Jana L. Kolarik Judge Leonard P. Lovitch and Rachel E. Ryu and Connor J. Leahy and Stacey A. Fehling and Michael S. Updates from the Fifth Circuit and Yuengert and J. Cohen and Mark E. Howell and Christi A. Have nonprofit, public, or tax exempt status; Have a governing board, the majority of whose members are patients of the health center.
FQHC clinical services requirements include: Patients must have access to all required services, access to specialty and hospital services, and after-hours coverage.
The location must be physically located on or near a major road or public transportation stop to ensure accessibility. Hours of operation must facilitate access to care by having early morning, evening or weekend hours. Ensure the appropriate mix of services for the target population to minimize duplication of services and maximize financial resources.
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