471 Neb. Admin. Code, ch. 29, § 006
FQHCs must bill for their services on Form CMS-1450 (see 471-000-51) or electronically using the standard Health Care Claim: Institutional transaction (ASC X12N 837). FQHCs must use the appropriate HCPCS/CPT procedure codes and revenue codes when billing for services.
FQHCs must bill for HEALTH CHECKS (Early and Periodic Screening, Diagnosis, and Treatment-EPSDT-Exams) on Form CMS-1500 (see 471-000-58) or electronically using the standard Health Care Claim: Professional transaction (ASC X12N 837).
FQHCs must bill all laboratory/radiology services and other non-FQHC services on the form CMS-1500 (see 471-000-58) or electronically using the standard health care claim; Professional transaction (ASC X12N 837) using the non-FQHC number.
471 Neb. Admin. Code, ch. 29, § 006