21-610 Understand Payment Requirements to Your Contracted Tribal FQHC
Date: 08/30/21
This information applies to Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to San Diego.
Make sure your contracted Tribal FQHC gets paid their full reimbursement
Per All Plan Letter (APL) 21-008 distributed by the Department of Health Care Services, Health Net and its participating physician groups (PPGs) must apply an Alternative Payment Methodology (APM) for eligible medical, mental health and ambulatory services provided by their Tribal Federally Qualified Health Centers (Tribal FQHC).
What PPGs need to know?
1 Continue to pay the Medi-Cal rate to contracted Tribal FQHCs for up to three visits per day, in any of the following combinations:
- Medical
- Mental health
- Ambulatory
2 Submit the encounter data to Health Net so we can pay the rate difference to the contracted Tribal FQHCs in accordance with the APM.
What are the Tribal FQHC APM Rates?
Beneficiary | 2021 rates |
|---|---|
Dual Rate (Medi-Cal beneficiaries with full Medicare coverage or Medicare Part B only) | $371.49 |
Non-Dual Rate (Medi-Cal beneficiaries that do not have Medicare Coverage or have Medicare Part A only) | $519 |
What are the provider types?
Indian Health Care Providers (IHCP) can operate as one of several clinic provider types, including but not limited to:
New provider type
| Existing provider types
|
The Centers for Medicare and Medicaid Services recognizes the Tribal FQHC as a new clinic provider type with corresponding service site parameters. IHCP may operate as only one of the provider types listed above.
Additional information
For questions regarding the information contained in this update, refer to APL 21-008 distributed by the Department of Health Care Services (DHCS) on May 12, 2021.
To review the list of the Tribal FQHC, refer to DHCS.
For all other questions, contact the Health Net Medi-Cal Provider Services using the information below.
Line of Business | Telephone Number | Provider Portal | Email Address |
|---|---|---|---|
Medi-Cal | 1-800-675-6110 |
| N/A |