|
|
MAPS-MD Issues Bulletin
November, 2000
Claim Department Address
Claims being sent through regular mail should still be sent to:
Effective immediately, if you are sending claims overnight for MAPS-MD you must address them to:
New Claim Explanation Codes
Two new Explanation (EX) Codes have been issued. They are the following:
Reminder: Emergency room codes R0451 and R0452
Revenue Codes 451 and 452 are not acceptable for emergency room charges, per Medicaid regulations.
Reminder: Long-term care spans if Medicare is primary
Reminder for Institutes for Mental Diseases (IMD): If Medicare is the primary insurance carrier and MAPS-MD is the secondary insurance carrier, a long-term care (LTC) span is not necessary. However, if MAPS-MD becomes the primary insurance carrier, a span becomes necessary.
Reminder: Spend downs for Inpatient Hospital Stays (Acute General Hospitals)
A spend down is a one-time-only reduction of assets to qualify for Medicaid. When a consumer comes into a hospital and applies for Medicaid, she/ he must list her / his assets so the State can make a determination regarding Medicaid eligibility. The spend down is the amount of the assets that must be reduced. For example, a hospital is told a consumer has $700 in their bank account. The State determines this money must be used as a resource before the consumer is eligible for Medicaid. MAPS-MD would reduce the payment to the provider by this amount and expect the provider to recoup the amount from the consumer. When a consumer has a spend down amount, the provider must include the following on the first UB-92 claim form for the admission: