FQHC Managed Care Forms

The 2016 Managed Care Visit and Revenue (MCVR) report and certification form must be submitted to the Department by July 10, 2017. Please email the completed MCVR and certification form as a pdf to the following address bmcr@health.ny.gov. Be sure to include the excel version of the completed MCVR report with your submission. The dates on the MCVR report and certification form must match.

The 2016 MCVR report includes a section for unpaid visits. This section is for informational purposes only and will not be used in the calculation of the supplemental payment rate. FQHCs should include visits, by Plan, where the Plan did not make payment to the FQHC.

Failure to submit the MCVR package by the July 10 due date may jeopardize your health center´s participation in the program for the October 2017 – September 2018 rate period.