Updated Billing Guidance for the Alternate Payment Methodology (APM) for Federally Qualified Health Centers (FQHC)
On May 1, 2023, the Office of MaineCare Services (OMS) released guidance related to billing and implementation of the updated APM for FQHCs. The notice included information regarding changes to services being provided outside of the FQHC encounter rate, but inadvertently omitted certain restricted services that should be billed as fee-for-service under a separate MaineCare provider billing number and Section of the MaineCare Benefits Manual (MBM). The information that was omitted in the guidance was presented during the March 30, 2023 Public Rate Forum, and also in the State Plan Amendment (SPA) notice posted on February 28, 2023. The presentation can also be found on the MaineCare Rate System Reform webpage.
OMS is sending this notice to clarify that the following list of service types must be billed under, and in accordance with, the applicable section of MBM policy:
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Section 5 - Ambulance Services
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Section 55 - Laboratory Services
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Section 60 - Medical Supplies and Durable Medical Equipment
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Section 80 - Pharmacy Services
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Section 101 - Medical Imaging Services
Providers who did not bill in accordance with this guidance for dates of service March 1, 2023 and after should reverse and rebill applicable claims to ensure proper claims processing and payments.
Please contact John Repecko Provider Relations Specialists, with questions.
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