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MAPS-MD Issues Bulletin
May 2001
Hospital-based Intensive Outpatient (IOP) Coverage for Uninsured Consumers
Effective July 1, 2001 MAPS-MD is enforcing the policy that the PMHS does not reimburse Intensive Outpatient Services rendered to uninsured individuals (who may be considered gray-zone-eligible for other services) in acute general hospitals or special psychiatric hospitals. However, IOP services rendered to uninsured individuals who are in non-hospital-based programs are reimbursed.
Reminder for IMD/RTC Providers – Long Term Care Spans
If a consumer is discharged from your facility to be admitted to another hospital, RTC, or nursing home facility, you must close the long-term care span. If a provider does not close the long-term care span to their facility, it will inhibit the other facility’s ability to open a long-term care span and / or to receive reimbursement.
Reminder: Billing Training Sessions for Providers
Pre-registration is required. Directions for all training locations and registration forms can be found at MAPS-MD.com. Check in for each session begins at 8:30 a.m. Training begins at 9 a.m.
| Location |
HCFA-1500 |
UB-92 |
| Calvert County Library |
May 23, 2001 |
May 24, 2001 |
| Carroll County Health Department |
May 31, 2001 |
June 1, 2001 |
| Baltimore City-Govans Presbyterian Church |
June 4, 2001 |
June 5, 2001 |
| Eastern Shore-Dorchester County Library |
June 11, 2001 |
June 12, 2001 |
| Western Maryland-Hancock Town Hall, 123 W. High St. |
June 14, 2001 |
June 15, 2001 |
| Anne Arundel County-Dept. of Agriculture-Annapolis |
June 29, 2001 |
July 2, 2001 |
HCFA training (Day 1) ; UB92 training (Day 2)
Trainings will review common mistakes with form completion, common denials and how to correct them, the electronic claims submission process, and the electronic explanation of payment. Also included will be tips and common questions and answers regarding authorizations and treatment plans.
Reminder: Preauthorization Requirements for the PMHS as of July 1, 2001
As indicated in the MAPS-MD Provider Manual, all services, with the exception of emergency services, must have pre-authorization, and subsequent care must be pre-authorized prior to the service being delivered. Beginning July 1, 2001, MAPS-MD will be strictly enforcing this policy. On rare occasions, outpatient types of service authorization can be back-dated for one month. If a pattern is noted that a particular provider is regularly requesting back-dated authorizations, this may trigger MAPS-MD to conduct an audit. Any requests for authorizations to be back-dated past one month for outpatient services, must be forwarded to the appropriate Core Service Agency. Inpatient retrospective reviews will continue to follow the same protocol as outlined in Chapter 10 of the Provider Manual.
Reminder: MAPS-MD Secondary Claims
When a consumer has a primary insurance other than Medicaid (MAPS-MD) the explanation of payment from the primary insurance carrier must match the services being billed to MAPS-MD. The explanation of payment from the primary carrier must be attached to the claim billed to MAPS-MD.
Reminder: Consumers calls related to billing issues
It is inappropriate for providers to instruct consumers to phone MAPS-MD regarding claims billing information. Providers may not bill Medicaid consumers any outstanding balances for unpaid or denied claims.