Rural Health Clinics

Rural health clinics (RHC) are designated by Medicare and the Centers for Medicare and Medicaid Services (CMS). When BCBSNE is the primary payor, RHCs and Federally Qualified Health Centers (FQHCs) must always file claims on a CMS 1500 claim form under the provider of service name, credentials and individual NPI, with Place of Service 72, using standard BCBS billing guidelines. BCBSNE does not follow CMS’s incident-to rules.       

When BCBSNE is the supplemental or secondary payor to CMS, you must include the attending provider’s name and NPI and the CPT and/or HCPCS codes identifying the services provided on the UB-04. The claims should automatically cross over to BCBSNE from Medicare, and the RHC or FQHC will be paid directly if the appropriate information is on the claim. RHCs and FQHCs should never submit Medicare supplemental/secondary claims on a CMS 1500.       

If you haven’t received BCBSNE payment after 30 days of the CMS-paid date on your remit, you should check the claim status. If the claim has not crossed over from Medicare, you will need to submit a UB-04 claim with the Explanation of Medicare Benefits (EOMB) for processing.