MAPS-MD Issues Bulletin

May 31, 2000

W9510 Interdisciplinary Treatment Team Planning

Recently, a change was made to the processing of invoices for W9510, Interdisciplinary Treatment Team Planning. Because regulations require that the treatment planning occur at least every six months, MAPS-MD will begin paying claims for this service if the difference between the date of service of the most recent billing for this service and the date of service on the invoice being processed is a minimum of 120 days. MAPS-MD will go back and reprocess claims with dates of service beginning on 7/1/99 and forward that have been denied because the date of service was prior to 6 months from the last W9510.

Other Insurance Denials

MAPS-MD has reprocessed the third party liability tape from Medicaid in an effort to do an eligibility refresh. It was discovered that MAPS-MD was receiving and accepting a flag for third party liability for categories in addition to other health insurance coverage (e.g. worker’s comp claims). As a result, MAPS-MD is reprocessing all claims with an other insurance denial (explanation code OC). If your organization has been affected by this, you will see the results of this reprocessing across the next several explanations of payment.

If within 30 days time you do not receive payment, you will need to check the following:

1. Did you indicate on the DCW that the patient had other insurance? If the other insurance was listed and has since terminated, have you sent an update in writing to MAPS-MD DCW department?
2. Did you check with the patient or DSS to determine if they have registered that they have other insurance coverage?

W9547 Rehabilitation Assessment Copays

MAPS-MD has reprocessed all W9547 claims received since August 23, 1999 that assessed a copay. A copay based upon the outpatient schedule was assessed for the W9547 claims incorrectly; the claims were reprocessed to assess the appropriate PRP copay amount.

90862 Medication Management (3/1/2000 rates)

MAPS-MD has reprocessed all paid 90862 claims for dates of service after 3/1/2000. The 90862 claims with dates of service after 3/1/2000 were previously underpaid. The correction has been made and the claims have been reprocessed.

Sign up for the Electronic Explanation of Payment

If you bill electronically you are able to receive the MAPS-MD Electronic Explanation of Payment. This is a fixed width text file that you can use to post your accounts receivable. Denial for duplicate of a previously paid claim is the #1 denial for providers across the state. Use this tool to help save staff time. Please fax the attached enrollment form to Vicky Franklin, Provider Relations Specialist, @ 410-953-1856.

Electronic EOP Request Form