For Medicaid - All claims must be received for adjudication and pass all edits including Med Link’s edits for dates of service July 1, 1997 through June 30, 1998, by April 1, 1999.

Resubmittals on denials received on March or early April EOP’s for claims related to services rendered July 1, 1997 – June 30, 1998 may be corrected and resubmitted up through May 15^th 1999. After May 15^th all Medicaid claims received for dates of service July 1, 1997 – June 30, 1998 will be returned without action.

For dates of service beginning July 1, 1998 and moving forward, these claims must be submitted and pass all edits including Med Link edits prior to the end of 9-months following the date the service was rendered. For claims submitted in the 8^th or 9^th month an additional 60-days will be granted for correcting and resubmitting claim denials that occurred on EOP’s dated in the 8^th or 9^th month following a rendered service date.

For Gray Zone – All claims must be received for adjudication and pass all edits including Med Link edits for date of service between July 1^st – August 31^st, 1998 by June 1^st 1999. Resubmittals on denials received on May or early June EOP’s for claims related to services rendered July 1, 1997 – August 31, 1998 may be corrected and resubmitted up through July 15, 1999.

For dates of service beginning September 1, 1998 and moving forward, these claims must be submitted and pass all edits including Med Link edits prior to the end of

9-months following the date the service was rendered. For claims submitted in the 8^th or 9^th month an additional 60-days will be granted for correcting and resubmitting claim denials that occurred on EOP’s dated in the 8^th or 9^th month following a rendered service date.

Medicare Co-Payments – Many PMHS Providers have been receiving vouchers from Medical Assistance for crossover claims with no payment included. The Mental Hygiene Administration has begun making payments on these vouchers.

In order to receive payment for these vouchers, please prepare the following:

1. A list of the date and amount of each voucher, totaled for all vouchers.
2. A copy of the last (summary) page from each voucher.

Please note that you should no longer be receiving such vouchers. In January, 1999, Medical Assistance corrected its program to assure that all appropriate claims are crossed over to Maryland Health Partners. Please contact Tim Santoni at 410-767-6655 if you are continuing to receive vouchers only for crossover services.

Y2K – Providers are reminded that January 1, 2000 is rapidly approaching. If you have a computer consultant who prepares your bills, you should make certain that they are prepared for the changes needed for the year 2000. If you have only microcomputers, software packages which will detect all year 2000 problems and fix many of them and are available from local vendors at a very nominal cost.

Diagnosis – Please remember that claims must be filed with a valid ICD-9 diagnosis. Acute Care Hospitals may now submit rendered service claims for any authorized service with any valid ICD-9 discharge diagnosis. (Does not have to be within ranges outlined in the Provider Manual.) Remember, 9-month filing rule outlined above.

Frequent Denial Reasons and Reconciliation – Attached is a matrix of the most frequent denials reasons we see at MAPS-MD and some recommended steps on reconciliation and resolution of these denial reasons. Click here to see the matrix...

IMD’s – As consumers transition to long term care (first day of first full month consumer spends in facility), it is essential that Medicaid eligibility be changed to reflect this fact. Providers must complete a form (Procedure and Form issued by MHA in late November), to effect Health Choice disinrollment and notify the appropriate local DSS office to change the consumer’s designation from community to institutional Medicaid status. In the very near future all claims for individuals who do not have the appropriate long term span opened within Medical Assistance will be denied.