by Jared Staheli
June 24th, 2015
The designated carrier and FI enroll IHS operated facilities, process IHS institutional claims, IHS physician and practitioner claims for IHS or tribally owned facilities and hospitals. The designated carrier may also enroll tribally operated facilities and process the practitioner claims for these facilities, if the tribally operated facility chooses. All intermediaries and carriers were notified of this selection.
Should other intermediaries and carriers receive misdirected enrollment requests or paper claims for IHS physicians or practitioners, they shall forward them to the designated carrier. However, the carriers that have tribally operated practitioners currently enrolled with them may continue to service these practitioners. In addition, for all tribally operated facilities, including Federally Qualified Health Centers (FQHCs) providing non-FQHC services, IHS physicians and practitioners may enroll with and submit bills to their local carriers, if they choose. Carriers shall service these tribally operated facilities and their practitioners in accordance with their normal procedures. However, IHS operated facilities may only enroll with and submit bills to the designated carrier. Tribally owned and operated facilities, while having a choice to bill their local carrier or the designated carrier, are prohibited from billing both entities.
See Chapter 1, §10.1.9 of Pub. 100-04, Medicare Claims Processing Manual, for more information on misdirected claims.