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2012 Texas Medicaid Provider Procedures Manual

Clinics and Other Outpatient Facility Services Handbook : 4. Federally Qualified Health Center (FQHC) : 4.4 Claims Filing and Reimbursement : 4.4.2 Reimbursement : 4.4.2.1 Medicare-Medicaid Crossover Claims Pricing

4.4.2.1
For FQHC Medicare-Medicaid crossover claims, Texas Medicaid pays the difference between the Medicaid encounter rate and any Medicare payment up to a maximum of the Medicaid encounter rate. If the Medicare payment is larger, no payment is made by Medicaid.

Texas Medicaid & Healthcare Partnership
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