Special Grants Available

SAMHSA's Center for Mental Health Services has made available funds to develop transition programs serving youths with "serious" emotional disturbances or mental illness as they enter adulthood. About $2 million is available to fund four to five cooperative agreements for four years each. The funds are available to states, Indian tribes or tribal organizations, counties, cities, the District of Columbia, and US territories Application kits are available by calling 800-789-2647. (Reprinted from the 3/4/02 issues of Behavioral Health Business News).

Reminder: Timely Filing/Appeals Business Rule

We continue to see an influx of claims that are repeatedly denied due to the timely filing and/or appeal statute. As a reminder, providers have nine (9) months to submit a claim from the date of service, and an additional 60 days from the date of the denial to correct a claim. Please advise applicable office staff of this rule.

Diagnosis Code Update (Revised Listing as of 3/28/02)

Download a list of the valid diagnosis codes accepted in the Public Mental Health System. All codes must be billed up to the fourth or fifth digit when applicable.

ER 450/451 Code Reminder

Total charges for Codes 450 (ER) and 451 (Triage) can only be billed with one unit and without span dates. Multiple units for these codes will be denied.

PRP Update

MAPS-MD has been instructed by the Maryland Hygiene Administration (MHA) to retract claims for onsite PRP services provided on the same day as medical day care. This is in accordance with COMAR listed below:

Medical Day Care Regulations: 10.09.59.05

.05 limitations.

The program does not cover the following:

• Services not specified in Regulation .04 of this chapter
• Services not medically necessary
• Investigational or experimental drugs and procedures
• Services denied by Medicare as not medically justified
• Rehabilitation services provided to HMO-MA enrollees as set forth in COMAR 10.09.16
• Rehabilitation services for recipients in an institution for mental disease as defined in 42 CFR §435.1009
• Rehabilitation services provided to hospital inpatients
• Rehabilitation visits solely for the purpose of prescribing medications or administering medications
• Separate reimbursement to an employee of a rehabilitation services program for services provided through a rehabilitation services program where the rehabilitation services program has been reimbursed directly
• Vocational counseling, vocational training at a classroom or job site, and academic or remedial educational services
• Services provided to or for the primary benefit of individuals other than the recipient
• Psychiatric rehabilitation program services other than those services that are specified in COMAR 10.21.21.05, .06A-E, .06-1B and C, and .07
• Mobile treatment program services other than those services that are specified in COMAR 10.21.19.05, .06A-E, .06-1B and C, and .07
• Outpatient mental health clinic services other than those services that are specified in
  OMAR 10.21.20.05, .06A-E, H, and I, and .07
• An onsite psychiatric rehabilitation program visit by a recipient on the same day that the recipient receives medical day care services under COMAR 10.09.07

New Claims Address

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

This address will replace the PO Box 624, Owings Mills, Maryland 21117 address.

Authorization Website Reminder

Each provider who has a Medicaid provider number will receive a login name and password for the authorization website. The purpose of this website is to verify authorizations that have already been issued. Once a provider has received the password, he should refer to the MAPS-MD website (http://www.mdhp.com) for instructions on accessing and utilizing the site. Please allow at least one business day for authorizations obtained over the phone and 10 working days for authorizations received via fax or mail to be posted on the website. If you are having trouble accessing the site, please email us.

Friendly Reminder Regarding Other Insurance Coverage and Crossover Billing

When a consumer is enrolled in other insurance, an Explanation of Benefits from the other carrier must be attached to the claim. A separate HCFA 1500 must be submitted for each claim listed on the Explanation of Medicare Benefits (EOMB). Codes and dates of service should exactly match the EOMB when payment has been made by Medicare. When Medicaid denies, MAPS-MD becomes primary and all submission guidelines for Medicaid should be followed. Failure to follow these guidelines will result in denied claims.

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