Wiki FQHC General Payer guidelines for a new biller

[jennbrad]

Can anyone help a new biller out? I work for an FQHC in Sacramento, CA and wanting to know the basic guidelines mainly for River City Medical Group Payer, I think they have the most requirements when submitting. Can anyone recommend some resources for me to check out please???

 

[Chelle-Lynn]

I am assume that River City is Managed Care Group in Sacramento? If so, your best bet would be to sit down with a representative from their office along with the contract and go through the groups requirements. We are an FQHC in California as well and have found that the Managed Care guidelines for the various local carriers can be different based on the individual contracts.

Also having a contact that you can work with one on one at their office will be a good resource as you move forward. Not sure if this is helpful, but when you are an FQHC provider, unless you are working with Medicare or Medicaid the rules can differ between the various managed care providers.