MAPS-MD Issues Bulletin

February 2001

Reminder: Attention UB92 Billers

  1. Outpatient UB92 claims billed with more than one day on a claim will be denied.
  2. Claims must include discharge status and discharge date.
  3. Outpatient UB92 claims billed with a late charge (135 bill type) will be denied. If a charge needs to be added since the original bill, a corrected bill with all charges for that day must be sent in to MAPS-MD (bill type 137).
  4. Please note that when you bill with a bill type of 137 the previous bill will be retracted. A common mistake made by providers is billing the additional charges only on a 137 bill type. This is incorrect.

Reminder: Information Regarding Modifiers, Billing codes, Reimbursement Rates on Web

Listed on the web site under "Provider Information" is information regarding modifiers, appropriate billing codes, and reimbursement rates for various CPT codes.

Electronic Submitters Can Receive Electronic EOPs

If you submit electronically, you are eligible to receive electronic EOPs. It is important that you make sure that you have filled out an electronic EOP enrollment form if you wish to receive this file. Please check your records and make sure you have completed an enrollment form. If you are currently submitting electronically and if you would like to get the electronic EOP but have not yet completed the enrollment form, please fill out the attached form and return to the fax number listed on the form.

Timely Filing Requirements

When Medicaid or gray zone is the primary carrier, claims must be submitted prior to the ninth month from the date of service in order to meet timely filing requirements. A claim that has been filed within nine months from the date of service and has been denied can be resubmitted for reconsideration of payment. To meet timely filing requirements for claims which have been denied and are being resubmitted, the claims must be resubmitted within 60 days following the ninth month from the date of service. After 60 additional days, a resubmittal of a denied claim will not be considered and will be denied for timely filing. (Example: date of service is 1/1/01. Claim is submitted and denied 2/1/01. The provider still has until 10/1/01 to resubmit the claim.) If Medical Assistance eligibility is established retroactively, the claim will meet timely filing requirements if it is filed within nine months from the date of the eligibility determination.

When Medicare is the primary carrier and Medicaid is the secondary carrier, the claim must be submitted to Medicare within nine months from the date of service. The provider has 120 days from the date on Medicare’s Explanation of Benefits to submit to MAPS-MD in order to meet timely filing requirements.

When a private carrier is primary and Medicaid is secondary, the claim must be submitted to the private carrier within nine months from the date of service or within the private carrier’s timely filing statute, whichever occurs first. The provider has 60 additional days from the date on the Explanation of Benefits from the private carrier to file the claim with MAPS-MD in order to meet timely filing requirements.

Tips Regarding Treatment Plans

  1. On reconciliation forms-in section 20 providers should state WHY they used more than the number of visits authorized.
  2. Providers should send in only one treatment plan for each client. Processing time is delayed when MAPS-MD has to return duplicate plans.
  3. Providers should send in treatment plans two weeks BEFORE they are due.
  4. Providers should state frequency of service in terms of times per week or times per month—not both.

How to appeal denials from treatment plans:

If you receive a treatment plan denial, you can appeal the denial by submitting written documentation supporting why this clinical service or the service frequency needs to occur. For expediency please attach the denied treatment plan with your supporting documentation to MAPS-MD, P.O. Box 3190, Columbia, MD 21045-7190, attn. UM Dept.

Authorization for PRP Services

Attention Psychiatric Rehabilitation Programs (PRP): Please do not call to have your cases authorized on the last three days of the month expecting the authorization to be back-dated to the first of the month. This practice results in longer-than-usual wait times for other providers having to have care authorized. PRP, like most other services, are to be "preauthorized," i.e. authorization is to be given before a service is delivered. Please comply with this requirement of the Public Mental Health System.