Timely Filing/Appeal Process

• First Appeal:
  Please submit first appeal with cover letter and supporting documentation to MAPS-MD's Appeal Unit.
• Second Appeal:
  Please submit the second appeal with additional supporting documentation and cover letter to MAPS-MD's Appeal Unit.
  
  (The first and second appeals should be forwarded to the following address)
  

MAPS-MD Claims Appeal Unit P.O. Box 3190 Columbia, Maryland 21045

• Third/Final Appeal:
  Please submit the third and final appeal along with the two denial appeal letters from MAPS-MD to the Mental Hygiene Administration (MHA) at the address listed below:

Retroactive Eligibility Verification

Maryland Health Partners will now accept the date of eligibility determination from the MMIS II recipient file as the definitive date of eligibility determination. Providers will have nine months from the retroactive determination date to file claims for services rendered to consumers for whom the determination was made between the date that eligibility begins to the date of the retroactive determination as indicated in MMIS II system.

In the case of hospital claims, a request for retrospective authorization along with appropriate documentation must be submitted within 9 months after obtaining retroactive eligibility. Failure to submit the medical file for retrospective review within the 9-month time period will result in a need to submit an appeal for timely filing.

UB Billing Update

All claims (inpatient and outpatient) with a discharge status in form locator 22 require an occurrence code of 42 as well as discharge date in form locator 32 - 35. This is inclusive of bill types 131 and 137. This process requirement has been in effect since May 2000. Effective August 25, 2002, claims without the proper occurrence codes will be denied.

UB92 Electronic Billing

If you are a hospital/facility that submits claims on UB92 claims forms, and are interested in billing electronically, please contact Vicky Franklin, EDI Coordinator for MAPS-MD @ 410/953-1837.

Fax Program Update

MAPS-MD currently has 4 incoming fax lines to better service our providers who are faxing treatment plans. To assist us in our customer service initiative, we are asking that you please limit your faxes to 25 pages per transmission. By faxing smaller amounts in one transmission, fax lines will be able to better accommodate all providers during regular business hours. Thank you for your cooperation.

Retraction Notice

This is a final notice to all providers who have claims payments that are to be retracted. Providers must contact MAPS-MD by August 1, 2002 in order to discuss and/or receive more detailed information regarding their proposed retractions. Retractions will begin for any providers who have not contacted MAPS-MD by August 5, 2002.

On-Line Provider Search

On June 10, 2002, MAPS-MD launched its new on-line provider search capability. This function is available on www.mdhp.com as well as the www.APS healthcareAssist.com consumer web site. This application will enable consumers to search the list of providers enrolled with Maryland Health Partners who can specifically meet certain criteria such as location and specialties. In addition, the application will also enable MAPS-MD Providers the ability to view their provider information on file with MAPS-MD. Please note, any discrepancies in the provider data must be submitted to the MAPS-MD Provider Relations Department in writing. Providers should complete the Provider Action Request (PAR) Form and fax or mail the form to Provider Relations:

Reminder: New Claims Address:

Effective June 1, 2002, all MAPS-MD claims should be sent to the following address:

PO Box 3000
Columbia, Maryland 21046

This address will be replacing P.O. BOX 624, Owing Mills, Maryland 21117

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