Federally Qualified Health Center/Rural Health Clinic Encounter – An encounter is a face-to-face in-person, telehealth, telemedicine, or teledentistry visit between a beneficiary and the physician, dentist or licensed non-physician practitioner who exercises independent judgment in the provision of medically necessary health care services that are part of the FQHC’s/RHC’s approved scope of project. (See Section 2 – A and C below for more information regarding telehealth, telemedicine, and teledentistry.) The provision of outpatient services must be recorded in the beneficiary’s medical record. FQHC/RHC personnel, as applicable, must be enrolled in the MA Program, hold valid, current professional licenses/certifications and must not be under sanction by either the Medicaid or Medicare Program. The defined encounter types are: Medical Service Encounter, Vision Service Encounter, and Dental Service Encounter. FQHCs/RHCs should refer to MA Bulletin 99-16-07, titled “Enrollment of Ordering, Referring, and Prescribing Providers” for additional information. (https://www.pa.gov/content/dam/copapwppagov/en/dhs/documents/docs/publications/documents/forms-and-pubs-omap/c_224393.pdf)
Clinical Personnel Encounter – An encounter is a face-to-face in-person, telehealth, telemedicine, or teledentistry visit performed by a physician or qualified Mid-Level practitioner, that meets the requirement for an encounter. The clinical personnel can be employed or contracted by the FQHC/RHC.
Telemedicine: An encounter between a practitioner and a beneficiary in which physical health services are provided through the use of approved electronic communication and information technologies to provide medical services at a distance. Telemedicine encounters must be provided according to the same standard of care as if delivered in-person. FQHCs/RHCs providing physical health services are to refer to MA Bulletin 99-23-08, titled “Updates to Guidelines for the Delivery of Physical Health Services via Telehealth,” or the current MA Bulletin or Department guidance, for more information (https://www.pa.gov/content/dam/copapwppagov/en/dhs/documents/docs/publications/documents/forms-and-pubsomap/MAB2023080201.pdf).
Telehealth: An encounter between a licensed practitioner or provider agency and a beneficiary, in which behavioral health services are provided through the use of approved electronic communication and information technologies to provide behavioral health care at a distance. Telehealth encounters must be provided according to the same standard of care as if delivered in-person. FQHCs/RHCs providing behavioral health services licensed by OMHSAS are to refer to OMHSAS Bulletin OMHSAS-22-02, titled “Revised Guidelines for the Delivery of Behavioral Health Services Through Telehealth,” or the current OMHSAS Bulletin or Department guidance, for more information (https://www.pa.gov/content/dam/copapwppagov/en/dhs/documents/providers/clearances-andlicensing/documents/mh-residential-licensing/Bulletin%20OMHSAS-22- 02_Revised-Guidelines-for-Delivery-of-BH-Services-Through-Telehealth7.1.22.pdf)
SOURCE: PA Department of Human Services, Medical Assistance Bulletin 99-26-01, Effective Jan. 1, 2026, (Accessed Apr. 2026).
Federally Qualified Health Center/Rural Health Clinic Encounter – An encounter is a faceto-face in-person, telehealth, telemedicine, or teledentistry visit between a beneficiary and the physician, dentist or licensed non-physician practitioner who exercises independent judgment in the provision of medically necessary health care services that are part of the FQHC’s/RHC’s approved scope of project. (See Section 2 – A and C below for more information regarding telehealth, telemedicine, and teledentistry.) The provision of outpatient services must be recorded in the beneficiary’s medical record. FQHC/RHC personnel, as applicable, must be enrolled in the MA Program, hold valid, current professional licenses/certifications and must not be under sanction by either the Medicaid or Medicare Program. The defined encounter types are: Medical Service Encounter, Vision Service Encounter, and Dental Service Encounter. FQHCs/RHCs should refer to MA Bulletin 99-16-07, titled “Enrollment of Ordering, Referring, and Prescribing Providers” for additional information. (https://www.pa.gov/content/dam/copapwppagov/en/dhs/documents/docs/publications/documents/forms-and-pubs-omap/c_224393.pdf)
Clinical Personnel Encounter – An encounter is a face-to-face in-person, telehealth, telemedicine, or teledentistry visit performed by a physician or qualified Mid-Level practitioner, that meets the requirement for an encounter. The clinical personnel can be employed or contracted by the FQHC/RHC.
Medical Service Encounter: An encounter between a physical health practitioner or a behavioral health practitioner and a beneficiary during which medical physical or behavioral services are provided for the prevention, diagnosis, treatment, or rehabilitation of illness or injury. Physical health services are those medically necessary services related to the treatment of bodily functions. Behavioral health services are those of a psychological nature or related to substance abuse treatment. The Department does not pay a separate medical physical health encounter for a medical service provided during a behavioral health encounter for the same beneficiary.
SOURCE: PA PROMISe, FQHC/RHC Handbook, Appendix E, Revised Nov. 1, 2024, (Accessed Apr. 2026).
Telemedicine: An encounter between a practitioner and a beneficiary in which physical health services are provided through the use of approved electronic communication and information technologies to provide medical services at a distance.
Telehealth: An encounter between a licensed practitioner or provider agency and a beneficiary, in which behavioral health services are provided through the use of approved electronic communication and information technologies to provide behavioral health care at a distance.
SOURCE: PA Department of Human Services, Medical Assistance Bulletin, Updates to The PROMISe™ Provider Handbook 837 Professional/CMS-1500 Claim Form, Appendix E – FQHC/RHC Handbook, Nov. 1, 2024, Number 08-24-16, (Accessed Apr. 2026).
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