Important update: group billable status for FQHCs and RHCs

On April 1, 2025, the following updates on billing processes will apply to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), based on their enrollment type in PRSS.

Claims from FQHCs and RHCs will be processed at the group level. Please ensure you comply with the following requirements when submitting claims. Claims that do not meet these new requirements may not be accepted.

When Medicaid is the primary payer:

• Bill the rendering NPI when required to submit a CMS‑1500 claim form.
• Place of Service (POS) codes:
• FQHCs should bill using POS 50.
• RHCs should bill using POS 72.

When Medicaid is the secondary payer:

• If Commercial insurance is the primary payer, utilize the CMS‑1500 claim form with the Place of Service requirements above.
• If Medicare is the primary payer, follow CMS guidelines for FQHC and RHC billing.

Enrollment and claims information:

• FQHCs and RHCs are enrolled in PRSS under the enrollment type Facility/Organization and can bill for all services using their facility/organization NPI.
• FQHCs and RHCs are not required to affiliate their practitioners in PRSS.
• Ordering, Referring, and Prescribing (ORP) practitioners at FQHCs and RHCs must be enrolled with DMAS as participating providers.

Contact us

Availity Chat with Payer is available during normal business hours. Get answers to your questions about eligibility, benefits, authorizations, claims status, and more. To access Availity Essentials, go to https://Availity.com and select the appropriate payer space tile from the drop‑down. Then, select Chat with Payer and complete the pre‑chat form to start your chat.

For additional support, visit the Contact Us section of our provider website for the appropriate contact.