Oakland Southfield Physicians

OSP News

Blue Cross Complete Claim Denial for FQHC/RHC and THC Notification

Posted: 01/05/2021

As a reminder to federally qualified, rural health and tribal health clinics, any claims that have been denied due to the attending NPI being missing on the claim need to be corrected and resubmitted. Your cost settlement could be adversely impacted until they’re rebilled, according to the Michigan Department of Health and Human Services.

Effective January 1, 2020, claims from FQHC, RHC and THC providers were appropriately denied when the attending NPI wasn’t reflected on the institutional format.  

The attending provider, whether a M.D., D.O. or medical director, should be listed on the claim form for a behavioral health service, even if there isn’t a direct relationship with that provider. Per the National Uniform Billing Committee, the attending provider is the individual who has overall responsibility for the member’s care. If a member is receiving behavioral health services from a licensed clinical social worker or licensed professional counselor, they may be doing so under the supervision of the M.D., D.O. or medical director in the clinic, even if it’s indirect supervision. The rendering provider should be listed on the institutional billing form as well.

The Michigan Department of Health and Human Services indicated that during a meeting with FQHCs/RHCs and THCs it was advised to rebill the denied claims. If you have received a denial for not reflecting the attending NPI, please resubmit your claims indicating the M.D., D.O or medical director.

For detailed information about the attending provider, see 2.3.B in Section 2 “How to File Claims” of the MDHHS Medicaid Provider Manual.

 

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