General Information:

Authorization Issues - In July and August, some claims were denied because of problems in the transition from authorization to billing. These claims are being automatically re-adjudicated. If payment is not received by October 15, 1998, please resubmit for those claims.

Past Outstanding Claims - If payment is outstanding for claims submitted for services rendered from 7/1/97 - 6/30/98 (which have not been shown as pended on your EOP), please resubmit those claims to MAPS-MD.

Supported Employment - Claims for supported employment have been re-adjudicated. If payment has not been received by October 20, 1998, please resubmit outstanding bills.

Interpreter Services - For one-half hour use CPT code W9548. For one hour use W9536. 1 unit = I hour: Example - 2 1/2 hours of services should be billed as 2 units W9536 and I unit W9548.

Home Health - ( CPT Code H 0001 ) - Referral guidelines are being developed and will be distributed in 2 - 3 weeks

Electronic Remittance - The final revisions with test providers is underway. This process will be available to all electronic filers for EOP’s posted after October 7, 1998

Mobile Treatment - A new code for mobile treatment will be available soon. This code will be used for Medicaid/Medicare crossover consumers and will be retroactive to 7/1/98 Instructions for authorization and billing will be issued in 2 - 3 weeks.

Consumer Satisfaction Surveys - Phone surveys with 1500 consumers have been completed. The results are being examined and a preliminary report is expected by mid-October. In addition consumers and family members have been trained to carry out face-to-face surveys and this process is underway in every region of the state.

FREQUENTLY ASKED QUESTIONS

1) How is urgent care defined?

Urgent care is defined in chapter 5 of the Provider Manual-Section 5.19 "Urgent Care" - Urgent care includes services delivered to prevent psychiatric crises, emergencies, and/or hospitalizations. Care is expected to be delivered within several hours of the individual presenting need.

2) When will the electronic transfer of funds be available?

MAPS-MD is developing a new main frame claim system. The electronic transfer of funds will be evaluated once the new claims system is in place, currently scheduled for February, 1999.

3) Is 90862 an interchangeable block code ?

Yes, 90862 is an interchangeable block code.

4. How can I ensure that MAPS-MD has received all my Authorization Plans?

You can use the "Authorization Plan Cover Page" found in the Provider Manual on page 17.32.0

MANUAL UPDATES and CORRECTIONS

Partial Hospitalization- Physician consultation for consumers within partial hospitalization programs can use the following inpatient codes to bill for rendered services:

99221-99223

99231-99233

99238-99239

99251-99255

99261-99263

Typo - Chapter 6, page 45 - 8^th Line Down

" Mental Disorders " should read as follows:

Mental Disorders due to a General Medical Condition. (Personality changes due to a Medical Condition is an included PMHS diagnosis).

Enhanced Support - Chapter 5, Section 5.8 (Claims section)

Claims section example - one unit = one hour

Example - When billing for 6 hours, bill for 6 units (6 hours = 6 units).

HCFA Billing Instructions - p. 16-3-0

This section reads correctly; but the following corrections should be noted:

16. 16-29-0 - Box "19" should read: "not required for OMHC’s"

HCFA Example #1 (OMHC): Box 19 should be empty and Box 33 should include OMHC nine digit MA#.

For clarification: Individual and Group practices must include MA# of rendering provider in Box 19, and the MA# of the individual or group that is to receive payment must be listed in Box 33. OMHC’s must only list MA# in Box 33.

Remaining Provider Training Sessions

October 27 - Mid-Shore (9:30 - 11:30)

November 2 - Montgomery County (1:00 - 3:00)