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Midwest Health Care Brochure

CAQH Standard Credentialing Package

RHC Fact Sheet May 2019

Chapter 13 Medicare Benefit Manual 12 20 19

Advance Beneficiary notice of Non-Coverage (ABN)

The mandatory use date has been changed from September to November, 2011 to accommodate those providers and suppliers with pre-printed stockpiles of ABN's so that they have additional time to exhaust their supplies of the outgoing ABN. The mandatory use date has been changed from September to November, 2011 to accommodate those providers and suppliers with pre-printed stockpiles of ABN's so that they have additional time to exhaust their supplies of the outgoing ABN.

                                       ABN Form Click Here (03/11)         ABN Instructions Click Here (03/11)

For more information regarding the mandatory use date of November 1, 2011 for the revised ABN, click here 

Missouri HealthNet New Forms for Managed Care Wrap Around Payments

Missouri HealthNet has introduced New forms to be used with the Wrap Around Payments for MO HealthNet Managed Care. 

Here are the forms you should begin using. Please be advised that these forms and rates are updated periodically. You should check with your state to verify:

Independent Rural Health Clinic, with Excel formulas.      Click Here     **Must save file to make edits

Independent Rural Health Clinic, without Formula             Click Here

Provider Based Clinic, with Excel formulas.                          Click Here

National Information  

Medicare Secondary Payer, All About It!

Rural Health Clinic Act PL95-210

CMS Medicare Signature Compliance Requirements

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide and Revenue Codes
CMS MLN Matters SE1039

CMS Mandatory Provider & Supplier Revalidation

In accordance with the Patient Protection and Affordable care Act, Section 6401 (a), all new and existing providers must be reevaluated under the new screening guidelines in Section 6028. Medicare requires all enrolled providers & suppliers to revalidate enrollment information every five years. Upon the CMS request to revalidate its enrollment, the provider/supplier has 60 days from the date of their letter to submit complete enrollment information by either paper application 855 form, or via the internet based PECOS System.

Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This applies to those providers and suppliers that were enrolled prior to March 25, 2011. Newly enrolled providers and suppliers that have submitted enrollment applications to CMS after that date are not impacted. Between now and March 23, 2015. MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier. Providers and suppliers must wait to submit the revalidation only after being asked by their MAC to do so.

Click here for a Sample Revalidation Letter.

Click here for a list of providers & suppliers that have been issued a letter in Phase 1.

Click here for a copy of SE1126 MLN Matters for further details on the revalidation of provider enrollment information.

Click here to be directed to the CMS site for more information on the mandatory revalidation.

Medicare Application Fee for Institutional Providers

Section 6401(a) of the Affordable Care Act (ACA) requires the Secretary to impose a fee on each "institutional provider of medical or other items or services and suppliers." The fee is to be used by the Secretary to cover the cost of program integrity efforts including the cost of screening associated with provider enrollment processes, including those under section 1866(j) and section 1128J of the Social Security Act. The application fee is currently $505 for CY2011; however, based upon provisions of the ACA this fee will vary from year-to-year based on adjustments made pursuant to the Consumer Price Index for Urban Areas (CPI-U). The application fee is to be imposed on institutional providers that are newly-enrolling, re-enrolling/re-validating, or adding a new practice location - for applications received on and after March 25, 2011.

CMS has defined "institutional provider" to mean any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A, CMS-855B (except physician and non-physician practitioner organizations), or CMS-855S or associated Internet-based PECOS enrollment application.

Click here to view CMS Medicare Application Fee Factsheet 

This is your link to the Welcome Page: 

For more information see the Institutional Provider Fact Sheet     Click Here

Medicare Enrollment for Physicians and Part B Suppliers -  Provider-Supplier Enrollment Fact Sheet

TrailBlazer Health Enterprises, LLC has released a New Rural Health Clinic Manual.

Even though TrailBlazer is no longer, the manual is considered a great tool for general knowledge.   
Click here to view.   

CMS Enrollment Forms

CMS 855A         Part A     Institutional Provider

CMS 855B         Part B     Clinics & Group Practice

CMS 855I          Part I       Physician and Non-Physician Providers

CMS 855R         Part R     Reassignment of Medicare Benefits, typically a provider is reassigning to a group.