MAPS-MD Issues Bulletin

March 2001

Helpful Tip: Preparation prior to calling MAPS-MD

When providers phone MAPS-MD they must have the consumer’s demographic information available. It is the provider’s responsibility before phoning MAPS-MD to determine if the consumer’s Medical Assistance is active or if the consumer has other insurance. Providers may determine if a consumer is Medicaid eligible by using Medicaid’s Eligibility Verification System (EVS). The phone number for EVS is 410-333-3020.

Reminder: Spend-down Deduction for Inpatient Hospital Claims

A spend-down is a one-time-only reduction of assets to qualify for Medicaid. When a consumer goes into a hospital for inpatient services and needs to apply for Medicaid, he/she has to list his/her assets, and the State makes determinations regarding Medicaid eligibility. A spend-down is the amount of the assets. For example, a hospital is told a consumer has a $700 resource amount. MAPS-MD would reduce the payment to the provider by this amount and expect the provider to recoup this amount from the consumer.

Spend-down amounts must be listed on the UB92 claims. Box 36 on the UB92 should contain occurrence code 80 and the dates that are listed on form 216. Box 39 should contain code D3 and the amount of the spend-down that is listed on form 216.

Reminder: Institutes for Mental Disease (IMDs)

Coverage for Medicaid Non-waiver Individuals for Inpatient Services:

The PMHS covers inpatient hospital stays for those adult individuals who are Medicaid recipients who are waiver-eligible and who are enrolled in an MCO. This coverage is for 30 contiguous days or 60 non-contiguous days in the calendar year.

Training Alert for Providers:

Keep checking for web updates on future MAPS-MD training sessions for providers. Sessions are to be scheduled in May and June in an area close to you. Training sessions will include reviewing the gray zone eligibility process, the authorization process, and billing procedures.