part ii policies and procedures for rural health clinic services

health clinics, and the UB-04 claim form for hospital-based rural healthclinics. Clinics should complete the appropriate form and forward it tothe Department‟s fiscal agent after each date of treatment. Detailedinstructions for completion of the CMS-1500 and the UB-04 arecontained in Appendix F of this manual.1001.7 Members with Medicaid/MedicareIf a member is eligible for both Medicaid and Medicare, all claims mustbe sent to the Medicare carrier first. Medicare upper limits ofreimbursement will apply for all services covered by Medicare. Policiesand procedures for billing those services are described in Part I, Chapter300.January 2012 Rural Health Clinic Services X-3