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NC Department of Health and Human Services
NC Division of
Medical Assistance

Federally Qualified Health Centers

DMA Clinical Policy and Programs
Phone Number 919-855-4260
Fax 919-733-2796

Federally Qualified Health Centers (FQHC) were added to the Medicaid program through an amendment to the Social Security Act, Section 6404 of Public Law 100-203.  The FQHC law established a set of health care services for which Medicaid recipients are entitled.  Medicaid FQHC services are defined as either core services or other ambulatory services.

For core service requirements, coverage criteria, and limitations, refer to Clinical Coverage Policy 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics.

Medicaid Bulletins

For changes and updates to coverage criteria, billing information, and other program requirements refer to the N.C. Medicaid general and special bulletins.

FQHC Financial Information

Core Billing Rates

In order to establish and maintain rates for FQHC providers, the following documentation must be submitted to N.C. Medicaid:

  • Enrollment letters from Centers for Medicare and Medicaid Services (CMS)
  • Enrollment letters from N.C. Medicaid Provider Enrollment
  • Both the initial and annually updated fiscal intermediary rate letters

Submissions may be by mail or fax to:

April High
DHHS-Division of Medical Assistance
Rate Setting Section
2501 Mail Service Center
Raleigh  NC  27699-2501
Phone: 919-814-0046
Fax: 919-814-0037

Fee Schedules

Cost Report and Prospective Payment System Rate Reconciliation Ready NC Connect NC
February 24, 2015