MAPS-MD Issues Bulletin

August 2001

Reminder: Faxed Confirmations for Treatment Plans, DCWs

MAPS-MD’s faxing of confirmations of receipt of treatment plans and DCW has been extended by MAPS-MD until the end of August. However, effective September 1, 2001, MAPS-MD will not fax confirmations of receipt of treatment plans and data collection worksheets. MAPS-MD is currently testing an authorization inquiry web screen to be accessed via the gray zone web site. A provider will be able to look up authorizations by consumer as well as all authorizations for the provider’s Medicaid number. Providers will be able to access information for authorizations with effective dates as old as one year. MAPS-MD will send detailed instructions including login and password information in the near future to each MAPS-MD provider with an active Medicaid number.

Reminder: Gray Zone Consumers with Commercial Insurance

As addressed in the July 2001 Web Update, the Maryland Public Mental Health System will not cover gray-zone consumers who have commercial insurance. Consumers affected by this are consumers who have only commercial insurance with mental health benefits, consumers who have only commercial insurance and have exhausted their mental health benefits, and consumers who have only commercial insurance and there are not mental health benefits.

Consumers not affected by the change are those who have commercial insurance as primary and Medicaid as secondary coverage and those who have Medicare as primary coverage.

Medicare/Medicaid Outpatient Services claims when Medicare did not cover the service:

The following procedure should be followed when billing for Medicaid consumers who have Medicare as primary, but Medicare has denied coverage of the service. This pertains to those services that Medicare normally covers (e.g. 90801, 90806, or traditional outpatient services).

In Box 11 of the HCFA 1500 Form use the Medicaid assigned insurance rejection codes listed below for third party liability rejection. The EOMB or appropriate letter from Medicare should still be attached to the claim for auditing purposes.

K= services not covered

L= coverage lapsed

M= coverage not in effect on service date

R= lack of response from carrier in 90 days

Clarification Regarding Bill Types 131 and 137

If a claim has been previously paid (even if the payment has been retracted) providers should bill using the 137 bill type (as opposed to bill type 131.)

Reminder: Address for Claims Submission

Please send all claims to P. O. Box 624, Owings Mills, MD 21117 unless claims are being overnighted. Sending claims in error to MAPS-MD’s street address in Columbia will cause a delay in processing.

Reminder: Address for Submission of Medical Records

Please do not send medical records with claims to P.O. Box 624, Owings Mill, MD because this address is for claims submissions only. Providers sending medical records for retro review should send them to P.O. Box 3190, Columbia, MD 21046.