IHCP bulletin BT202511 1/30/2025
Effective immediately, FQHCs and RHCs should begin submitting the NOP on the same claim as other encounters for the visit. No claims for NOP should be submitted separately as of Jan. 30, 2025. Gainwell Technologies will be mass-adjusting claims for wrap payments with dates on or after Jan. 1, 2023, to correct those claims that experienced underpayments.
In a previous IHCP Bulletin: BT202312 Feb 21, 2023, FQHCs and RHCs were instructed to temporarily submit NOP claims separately from other encounters without the T1015 code until Gainwell updated the system to exclude the new NOP code (G9997 TH) and modifier from the sum of all payers. Claims with T1015 would result in underpayment for FQHCs and RHCs. As a result, FQHCs and RHCs may experience underpayments in their wrap payments until system updates are made to incorporate the new NOP billing code G9997 TH in place of the discontinued code.
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