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Authorization Requests:
1. When calling MAPS-MD for authorization, you must provide MAPS-MD with your nine digit Medical Assistance Provider number. This number must be the billing Provider number for your practice or program. ProvidingMAPS-MD with this number at the time of authorization will help to ensure accurate claims payment.
2. When requesting authorization for a Medicaid Consumer, you should always verify the MA number through EVS. When requesting authorization for a Gray Zone Consumer, you should always verify their Social Security Number through the Gray Zone Web Site www.gzmd.com.
3. When completing Treatment Plans, you must provide a phone number. The number should be for a contact person that can provide information regarding the Treatment Plan.
Payment and Denial Issues:
1. Providers that continue to receive denials from MAPS-MD for Consumer eligibility reasons, when the Provider shows the Consumer as eligible, should forward examples of these issues to the appropriate Core Service Agency. This will allow the CSA’s to work with Medical Assistance on "cleaning up" possible eligibility problems.
2. Should you receive an overpayment or duplicate payment from MAPS-MD, you should post all correct payments on the EOP and cash the check. You should then notify MAPS-MD in writing of the payment error. MAPS-MD will then initiate the recouptment procedure and request a refund from the provider. Providers should never return money to MAPS-MD until they have received a Recoupment Letter requesting the funds. Providers will then have 30 days to return the funds to MAPS-MD or the overpayment will be offset against future claim payments. You can send notification of payment error to the following:
Gray Zone Information:
Please remember to include your fax number when completing the Data Collection Worksheet. This will help to ensure timely return of the completed DCW.
Electronic Billing:
MAPS-MD would like to remind and encourage all Providers that MAPS-MD is capable of receiving electronic claims. Electronic claims can be filed via MAPS-MD’s subcontracted electronic billing intermediary Medlink. What are the benefits of submitting electronically?
Medlink can and will work with other electronic billing intermediaries that providers might be using. However, MAPS-MD strongly recommends a direct link with Medlink as this will help to reduce technical problems that might occur as a result of submitting through multiple intermediaries. For more information about electronic billing and Medlink, please call the following:
New MAPS-MD Claims System:
MAPS-MD will be converting to a new computer system for claims processing. The new system will be an Amysis based system and the conversion will occur within the next 45 days. Operationally, there will be no changes in your billing procedures. However, you will see some changes in the data that is returned to you, specifically with the Explanation of Payment (EOP) and the Explanation (EX) Codes. A conversion matrix of current EX codes to the new Amisys codes follows:
click here for Conversion Matrix
Retrospective Review:
It has come to our attention that some providers have been sending medical records for retrospective reviews directly to INTEGRATED HEALTHCARE AUDITING AND SERVICES, INC (IHAS) instead of directly to MAPS-MD. We (MAPS-MD) want to discontinue this practice. Effective immediately, medical records for retrospective review should be sent to:
This will ensure a more timely response to retrospective review inquiries and reimbursement considerations. Additional information can be found on page 10-2-0 of the MAPS-MD provider manual. For questions regarding the retrospective review process, you can call the following: