MAPS-MD Issues Bulletin
July, 1999

Recoupments of Duplicate Payments:

MAPS-MD has initiated a process to begin recouping any duplicate payments that have been paid to providers in error from July 1, 1997 to current. You will see these recoupments on either EOP 669 or 671, and the original payment line in addition to the adjustment line will be reflected on the EOP. Should you have questions regarding specific overpayments you should call:

MAPS-MD Claims Customer Services
800-565-9688

Physician Group Practices and HSCRC Regulated Hospital Clinics:

For those Physicians Groups that provide services in HSCRC regulated hospital clinics, it is unnecessary to request authorization and/or submit Treatment Plans to Maryland Health Partners. It is the responsibility of the hospital to obtain the proper authorization. However, to be reimbursed for these services, MAPS-MD MUST have on file the link between your Physician Group Practice and the corresponding hospital. Therefore, you should send MAPS-MD notification of all hospitals at which you provide services to MAPS-MD consumers. This information can be sent to the following:

Robert Atwood, Manager, Provider Relations
Maryland Health Partners
7172 Columbia Gateway Drive, Suite B
Columbia, MD 21046

Please note, for services rendered outside of the hospital clinic (i.e.: in your private office) you must follow standard MAPS-MD authorization policies and procedures.

Authorization and Treatment Plan Procedures

• Please remember to use the consumer's legal name on the Treatment Plan or when calling MAPS-MD. Using nicknames or middle names causes delays in processing your request and in many instances, the treatment plan may be returned, as MAPS-MD will not be able to identify the consumer. Also, if the consumer has a specific title (i.e.: Jr. or II) please be sure to use these as well, as it will help MAPS-MD to identify the consumer.

• Be aware that faxing and mailing your Treatment Plans will only cause a delay in processing, as MAPS-MD has to process your request twice. Please choose one method, either mail or fax. Also, please do not fax your Treatment Plans more than once. MAPS-MD is experiencing an increase in duplicate Treatment Plans due to multiple faxes for the same consumer. Again, this will delay Treatment Plan processing.

• If you have submitted a Treatment Plan and have not received a response from MAPS-MD within 30 days, you can submit a "missing authorization" list to MAPS-MD to be researched. These requests should be sent to the following:

Maryland Health Partners
P.O. Box 3190
Attn: Utilization Management

• Just a reminder, Treatment Plans only need to be submitted to MAPS-MD when further authorizations are being requested. It is not necessary to submit a Treatment Plan to confirm authorizations received via phone. This is also applicable to interchangeable services (see "Service Matrix in the Provider Manual"). For example, if you have obtained authorization for thirty 90806’s and seven 90862’s, then you may bill for thirty-seven units of Block "A" services, and it is not necessary to request additional authorization.

• Please do not ask consumers to call MAPS-MD for issues concerning treatment plans. This leads to a great deal of confusion for the consumer. If a consumer is changing providers, the provider must call MAPS-MD to inform them of the change.