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Erroneous Reimbursement Rate for FQHC and RHC Local Codes

May 17, 2017

The Department of Health Care Services has identified an erroneous update applied to local codes billed by Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) that use the established Prospective Payment System reimbursement rate. Providers may have noticed an increase to their rates on file. Corrections to these rates were made on April 27, 2017. Any claims adjudicated after this date will have the correct rate applied.

Overpayments will be recouped through the quarterly Erroneous Payment Correction process. Providers should continue to submit claims in a timely manner. Providers can direct questions regarding rates to the Telephone Service Center at 1-800-541-5555.