General Information:

Discharge Summary: A Discharge Summary must be provided to MAPS-MD immediately upon a consumer’s discharge from a facility. You can use your own form or the form provided in the Provider Manual (p. 17-15-0).

Home Health Referral Guidelines: See attached memo from DHMH

Qualified Medicare Beneficiaries - must be billed using the Consumer’s Medicaid number for services not covered by Medicare. No co-pay will apply to non-Medicare covered services. Any past services paid incorrectly should be rebilled on paper to the attention of:

"Attn: Claims Manager"

"Re: Qualified Medicare Beneficiary Billing"

Gray zone co-pays - should be calculated accurately at this time. MAPS-MD will not reprocess co-pays on claims for dates of service between July 1, 1997 and October 15, 1998 unless a provider specifically requests reprocessing. In most cases, reprocessing of claims for co-payment adjustments will not benefit the consumer / provider. Please call Claims Customer Service with specific questions.

Residential crisis - denials for July 1, 1998 to October 15, 1998 have been readjudicated (W9548 / W9513).

HMO Managed Denials - Inappropriate HMO managed denials were readjudicated (C61, C62).

PRP Duplicate denials - Inappropriate denials for two separate PRP programs delivering services on the same day were readjudicated for dates of service between July 1, 1997 and October 15, 1998. These were previously denied as QD (duplicate claim).

Membership Update - MAPS-MD is currently processing a membership update from the State Medicaid. Upon completion, MAPS-MD will readjudicate all denials /pends related to membership from July 1, 1997 to current dates of service (C08, C28, C61, C62, QMB).

Medicare Updates -
All Medicare Part A cross over claims are now up to date.
All Medicare Part B cross over claims are now up to date.

Electronic Remittance Advice - ERAs (electronic EOPs) have been posted for HCFA providers. UB92 providers should have ERA’s posted by the end of December. Providers must return the registration form for ERA by December 31, 1998 to continue to receive the ERA. This has been extended from the previous deadline date of November 15, 1998. By returning the form, providers are agreeing to discontinue paper EOPs after December 31, 1998 and continue the ERA. Providers may sign up after December 31, 1998 to receive the ERA; however, after December 31, 1998 providers will not automatically receive the ERA unless they have completed the registration form.

Medlink Update:

Report update - If you submit HCFA 1500s electronically, the following is currently available to you:

(1) Status report: Lists each claim submitted in the batch with a status of SUB (submitted) or REJ (rejected). This report is the result of Medlink’s edits (also known as level I edits).

(2) Error Log report: Lists each claim listed on the Status report with a status of REJ. THESE MUST BE CORRECTED BY PROVIDER AND RESUBMITTED. These are rejected claims due to the claim not passing edits performed by Medlink (level I edits).

(3) Payor Report Lists each claim that was sent to MAPS-MD by Medlink that was rejected by MAPS-MD (also known as level II edits). THESE CLAIMS MUST BE , CORRECTED AND RESUBMITTED. THESE CLAIMS WILL NOT APPEAR ON A FUTURE EOP IF THEY ARE LISTED ON THIS REPORT.

You must dial into Medlink to access these reports.

UPCOMING REPORT SCHEDULED TO BE RELEASED BY DECEMBER 31, 1998:

Payor Status report: This report will list each individual claim in the batch that passed Medlink level I edits and sent to MAPS-MD. Each claim will have either a status of processed or rejected, indicating if MAPS-MD rejected the claim or accepted it for processing. Anything rejected, will appear on the payor report. Anything marked as processed should appear on a future EOP.

MORE DETAILS WILL BE GIVEN ONCE THE NEW REPORT IS READY FOR RELEASE.

Provider Manual Corrections:

Correction-Chapter 1 page 1-4-0 should have: Baltimore County CSA Phone No. (410) 887-2731 Fax No. (410) 887-4859

Mid Shore CSA Change of Address & Phone No.

New Address 8706 Commerce Drive - Suite 3 Eastern, Md.

Phone No. (410) 770-4801 Fax No. (410) 770-4809

Gray Zone Information On the Data Collection Worksheet (DCW), "Other Insurance" includes Medicare. You must inform MAPS-MD if the consumer is a Medicare recipient.

Billing Reminders: The following services need to be paper billed on HCFA1500 forms to MAPS-MD Claims Department PO Box 624 Owings Mills Maryland 21117-0624 (these services can NOT be accepted via EDI):

W9528- InHome Respite (enhanced support)

W9534- Intensive level Job Coaching

97530- Occupational Therapy

97535- Occupational Therapy

97537 -Occupational Therapy

97770 -Occupational Therapy

97150 -Occupational Therapy

W9511- Community Prevention

96100- Testing