Common use of RHCs Services Clause in Contracts

RHCs Services. Rural Health Centers will continue to bill the MCO, and the MCO shall follow the procedure as follows: 3.17.2.1 The MCO shall adjudicate Medicaid claims as a zero pay for services provided to the MCO’s Enrollees at a RHC. 3.17.2.2 The MCO will forward these adjudicated claims to the STATE within seven (7) calendar days of adjudication and will submit the claims in a weekly file submission.  Claims in which Medicare is primary and the claim is paid in full are not to be included in the weekly file submission.  Claims for which another payer (TPL) is primary, the claim is paid in full and $0.00 is assigned to patient responsibility are to be excluded from the weekly file submission 3.17.2.3 The STATE will adjudicate the Medicaid claims for the RHC and provide the MCO with a Remittance Advice for the processed claims. The MCO will be required to submit a separate encounter claim for these transactions. The STATE will provide technical specifications for this process and will post the document on the managed care webpage. The MCO and STATE will continue to collaborate through a workgroup to monitor the implementation progress of this section and address concerns about the process. 3.17.2.4 The MCO will submit a quarterly data report of RHC copayments for service dates on or after January 1, 2015. The MCO shall provide the data report in a format specified by the STATE within thirty (30) days of the end of each quarter.