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MAPS-MD Issues Bulletin
June 2001
Nursing Home Psychiatric Consultations
Nursing Home Psychiatric Consultations are categorized as Special Mental Health Services because they are provided on a short-term basis to prevent psychiatric hospitalization. Maintenance mental health services for consumers in nursing homes are expected to be covered by the nursing homes under the day rate paid by Medicaid (MA). Specialized mental health services are not covered by the MA day rate. Specialized mental health services will be paid for by the Public Mental Health System if pre-authorized by MAPS-MD and if they meet medical necessity criteria. Specialized mental health services are defined as inpatient mental health services or psychiatric consultation services which are necessary to avoid psychiatric hospitalization.
Nursing Home Consultations are provided on a short-term basis to prevent a psychiatric admission. An initial consultation in the Nursing Home will be authorized by MAPS-MD to evaluate the severity of a consumer’s psychiatric problem. Additional services (up to five visits) by the psychiatrist will be approved only for consumers with a mental illness severity level which puts them at risk for hospitalization (i.e. the consumer is exhibiting behavior that is threatening to self or others, or the consumer is experiencing a deterioration of functioning and becoming increasingly at risk for hospitalization.) The consumer must have a PMHS-covered diagnosis.
The mental health service provider is expected to exchange information and coordinate care with the consumer’s primary care physician and other treatment (i.e. substance abuse treatment) providers when clinically appropriate.
Summer Camp Authorizations
Individuals who are approved by MAPS-MD for "Summer Camps" must be evaluated and referred by a mental health professional, have a Severe and Emotional Disorder (SED) diagnosis, and meet the medical necessity criteria for PRP, or outpatient mental health services (Category A) in the frequency and intensity of service being requested. Contact your Core Service Agency for additional information about this service.
Reminder: Provider Information Updates
Please make sure that if a provider changes locations, phone numbers, or fax numbers, that MAPS-MD is notified in writing of the change. This will help MAPS-MD refer consumers appropriately and enable MAPS-MD to correspond with providers in a timely manner. If MAPS-MD is not notified of these demographic changes, it will cause authorization letters or payment to be delayed. Providers should use the Provider Action Request (PAR) Form for updates. This form is listed on the MAPS-MD web-site (MAPS-MD.com)
Claims Appeals for Timely Filing
Providers who wish to appeal a claim for timely filing may do so by using the procedure detailed below.
Providers must submit the following in writing to MAPS-MD Claims Appeals, P.O. Box 3190, Columbia, Maryland 21045-7190:
MAPS-MD will follow up with a letter of decision in response to your appeal.
Appeals should only be for claims denied for timely filing. All other denials for claims still within filing statute should be followed up with Claims Customer Service Representatives or resubmitted.
Reminder: Whiteout is Not Allowed on Claims
Please note that it is not permitted to use whiteout on claims. Claims submitted with whiteout will be returned unprocessed to the provider.
Reminder: Regarding Attachments to Claims
Please do not send in multiple claims with only one Explanation of Benefits (EOB) attached when MAPS-MD is the secondary payer. Please note that providers are responsible for making copies of the EOBs. Providers must attach one copy of the appropriate EOB to EACH claim submitted. Providers receiving denials stating "submit Medicare EOB" should check to ensure that billers are following appropriate procedure described above.