From: Brian Heburn, Acting Director , MHA

To: All Providers

The proposed rate changes contained in COMAR 10.21.25, published in the Maryland Register on September 20, 2002, which affect Outpatient Mental Health Centers (OMHC), are being considered by the Joint Committee on Administrative, Executive and Legislative Review (AELR). A hearing has been scheduled for November 12th.

However, as you are aware, Maryland Health Partners (MAPS-MD) has been paying OMHCs the higher rate since July 1, 2002, anticipating that the emergency regulations submitted by MHA implementing the rate changes would be approved by AELR, and be made effective July 1, 2002.

Because AELR has not approved the emergency regulations, and given the current timeframes, MHA is concerned that the effective date for the new rates may be later than July 1st. Depending on when AELR makes the regulations effective, it may be necessary to decrease future payments to offset the higher payments that were not approved. MAPS-MD will notify you of the final decision made by AELR.

MAPS-MD System Migration

Maryland Health Partners is in the process of migrating to a new integrated claims and clinical system. While this change will enhance all services to you, we do ask for your patience during transition. This change will enhance claims payment to our providers and be transparent to the users with the following exceptions:

Authorization and Non Authorization Letters:

You will also notice some minor changes in the authorization letters. In the top right hand corner of the letter the ID# translates to the consumers Medical Assistance Number. The Case # is also the authorization number and is necessary in researching questions regarding authorizations. As requested by the provider community, the authorization letter will now reflect the number of services the provider requested, the number of authorized services, as well as the authorization number. (Please see "Authorization Number Format").

The "non-authorization" letters will parallel the authorization letters, however in the body of the letter the last line of the first paragraph will state "care could not be certified as medically necessary....." The next section will reflect that the provider requested "x" number of services/days and "0" days were authorized which indicates that there is a non-authorization of service. As before, all levels of appeal are noted on the letter.

Authorization Number Format

In the upcoming weeks you will notice a change in the format of authorization numbers from MAPS-MD. The new format for authorization numbers is as follows:

Outpatient:
9-10 numeric digits for the authorization number
4 numeric digits for the detail record

Example:
Outpatient
000018236 0001

Inpatient:
9- 10 numeric digits for the authorization number
1 alpha character & 3 numeric digits for the detail record.

Example:
Inpatient
000018696 A123

For authorizations converted from the original clinical system, the following format applies:

Inpatient and Outpatient:

2 Alpha characters (always 'CA')
8-10 numeric digits for the authorization number
4 numeric digits for the detail record

Example:
CA2900035210 0001

All additional authorizations made to this converted authorization number will maintain this format.

*Please Note: The last four digits of the authorization number are considered the "suffix" and are not necessary to enter into your billing system.

Example:
000018236 0001

(000018236)- authorization number (0001)- suffix

*It will however be necessary to reference the entire number (both authorization and suffix) from your authorization letter when contacting Care Management.

Maryland PMHS Consumer Satisfaction and Outcomes Survey: 2002

The Maryland Public Mental Health System Consumer Satisfaction and Outcomes Survey will be administered beginning this month, October 2002. The initiative seeks direct consumer input on satisfaction with public mental health system services, as well as consumer self-evaluation of functional outcomes as a result of those services. The Mental Hygiene Administration has charged MAPS-MD with coordinating this survey effort as a part of its evaluation of the public mental health system.

This survey represents the third systematic, statewide assessment of satisfaction and outcomes of consumers of public mental health services. The adult and child/family survey instruments have been updated and include items from the Mental Health Statistics Improvement Program (MHSIP) Adult and Youth Consumer Satisfaction tools. This year's survey will focus on satisfaction with and outcomes of outpatient, psychiatric rehabilitation services and family support services.

Telephonic interviews are administered to a sample of adults and parents/caregivers of children. The interviews are conducted by Northrop Grumman Information Technology Health Solutions, and services to support independent data collection and analysis. The survey protocol has been reviewed and approved by the DHMH Institutional Review Board. All potential participants are notified of the survey project by letter, and given an opportunity to indicate their wish to participate or be excluded from the sample.

Findings from the surveys will be made available to consumers and providers; in addition, data from the survey will also be submitted by MHA for the Center for Mental Health Services State Data Infrastructure Grant for Uniform Reporting System on the Community Mental Health Service Block Grant.

Please feel free to contact Mary Shorter-Fahimi, Director of QI & Evaluation, MAPS-MD at (410) 953-1830 with any questions regarding the survey.

Grayzone/Authorization Websites:

MAPS-MD's Information Systems Department has been receiving calls from providers requesting passwords, logins, and various other information. ALL requests should be made via E-Mail to: Info@GZMD.COM.

Please respond with the following information:

1. What do you want to connect to? The Grayzone Website or Authorization Website?
2. Provider's name.
3. Provider's address.
4. Provider's telephone number.
5. Provider Medicaid number.
6. Contact person on file.
7. Login and Password that you are trying to gain access with.

Please Note: The contact person's name must match with what we have on file.

WEB Sites:

Grayzone/Auth. HTTP://WWW.GZMD.COM/

(same Web address, different log-ons)

General Information HTTP://WWW.MDHP.COM/

Please pass this information on to your employees.

MAPS-MD's Consumer Website

Beginning September 5, 2002, we will require that all visitors to APS healthcareAssist (MAPS-MD's Consumer Web Site) have 128-bit encryption in their Internet browsers. Please see the following attachments regarding this change as well as common Q&A's to help guide you.

UB92 Electronic Billing

If you are a hospital/facility that submits claims on UB92 claims forms, and are interested in billing electronically, please contact our, EDI Coordinator for MAPS-MD @ 410/953-1837. Clean claims processed electronically are generally processed within 5-7 days.

FYI- Please send all checks that require adjustments to:

Clinical Updates:

Medical Necessity

MAPS-MD clinicians review treatment plans for medical necessity and will authorize care based upon the medical information obtained for this decision. Please note:

• It is the provider's responsibility to determine eligibility and benefit information.
• Certification for medical necessity does not guarantee financial reimbursement related to eligibility and benefit matters.

Rehabilitation Assessment

Prior to October 1, 2002 PRP providers would receive a separate authorization for the Rehabilitation Assessment. MAPS-MD learned after we moved to the clinical front end system that is in sync with the claims system that we cannot have overlapping date spans for the Rehab Assessment and ongoing Category D. In order to accommodate the providers need to have a Rehab Assessment MAPS-MD has added one additional PRP visit to the Category D authorization when a Rehabilitation Assessment is requested.

Grayzone Spans

Providers are encouraged to verify that the Grayzone consumers they are treating have an active Grayzone eligibility span. The Grayzone span can be verified by looking at the Grayzone web site. If a consumer does not have an active Grayzone eligibility span the provider would call MAPS-MD @ 1-800-888-1965 and ask a customer service representative to establish a Grayzone span. In order for an authorized Outpatient service to be paid the consumer must have eligibility, either Medical Assistance, Pharmacy Assistance or an established Grayzone span.

Therapeutic Behavioral Service

The Public Mental Health System is actively recruiting for providers of the Therapeutic Behavioral Service. OMHC, PRP, and Mobile Treatment Team Providers are eligible to provide this service.

Authorizations for Outpatient Services

New consumers to the PMHS requesting outpatient services receive 12 unmanaged visits for a 12 month period of time. When these unmanaged visits are almost exhausted the provider submits an authorization plan to MAPS-MD. Because of the issue with overlapping dates MAPS-MD will add the twelve unmanaged visits to the amount of clinical services being authorized for the concurrent review.

Retrospective Review

When billing for a retrospective review, please attach the letter authorizing the services to the claim, and print or stamp RETRO REVIEW on the claim.

Q&A's from Provider Training 2002

Clinical Questions:

Q If the consumers Grayzone span termed before 7/1/02 does the consumer have to re-register with MAPS-MD?
A. Yes, they must be re-certified.

Q. Will the contract be revised for the OMHC to be handled the same way as PRP?
A. Though this is not currently in place, MHA is moving in that direction. The same five criteria will be applicable as the PRP grant program.

Q. Will this be out of the same grant money?
A. Possibly. You may want to contact your CSA for alternative treatment.

Q. Are there still two initial visits?
A. If the consumer does not fall within the guidelines for the priority group, you must contact the CSA. If the CSA approves service, two visits will be authorized by MAPS-MD. If the CSA approves additional services, up to an additional 10 visits will be authorized.

Q. What telephone number should be used for faxing clinical information?
A. 410-953-1903

Q. Who should be billed for EPSDT services?
A. If a non-PMHS (Public Mental Health System) diagnosis is the primary diagnosis, MAPS-MD will authorize service but the claim would go directly to Medicaid. If the primary diagnosis code is one of the accepted PMHS diagnosis codes, the claims would be submitted to MAPS-MD.

Q. When we, the provider, requests authorization and the request is denied, we receive a letter of denial. When we appeal the denial we do not receive a letter letting us know of the decision. Should we be getting a letter?
A. Yes, you should be receiving a letter regarding the decision of your appeal.

Q. What should we do when you have an authorization letter but the authorization is not on the authorization website and the claims are being denied for lack of authorization?
A. Contact customer service to verify your authorization information, consumer information and provider information. Often, there is a breakdown in one of the listed areas that can easily be corrected. Verify that you did not submit your claim prior to the authorization transmission into the system. This is typically the issue when billing electronically. In this case you should resubmit your claim.

Q. Who do we contact if the authorization received is not what was requested or is under a different provider MA#?
A. You should call the clinical line @1-800-888-1965 to have the authorization corrected.

Q. What can we do when a discharge summary has been sent and the consumer returns for treatment? The care manger will not give authorization because the consumer still has authorization showing because the discharge summary has not been entered into the MAPS-MD system?
A. Inform the care manager that the discharge summary letter had been sent and request that the care manager closeout the old case and open a new case for current treatment.

Q. What is a reasonable time frame for obtaining authorization including wait time?
A. Review time should not take longer than fifteen minutes.

Compliance:

Q. When you decide to do an audit, do you go to all of the divisions or just one?
A. Typically just one, but if you are aware of systemic problems then perhaps you should consider creating a compliance program.

Q. How do I start a compliance program?
A. Please refer to the handout (handed out at each training session) to determine what your company may need to set up a compliance program. If you do not have the handout, you may contact MHA to have one mailed to you.

Eligibility

Q. MAPS-MD is denying claims because income verification was not on file. If MAPS-MD no longer requires DCW's (Data Collection Worksheet) to be submitted, why are claims denying for this reason?
A. If the consumer's DCW was submitted prior to 7/1/02, the income verification was required. The consumer must now be re-certified with MAPS-MD and will be issued a $2.00 co-pay. Keep in mind that although MAPS-MD does not request that a DCW be submitted, the provider is expected to retain a completed DCW in the consumers file.

Q. Sometimes we check EVS (Eligibility Verification System) on Monday and the consumer is eligible; but on that Friday the same information on the consumer will come up as not eligible. What can we do to get claims paid?
A. Medicaid supplies MAPS-MD with the same information that is in the EVS system. The consumer may have moved from one eligibility group to another, or the consumer may need to be registered as Grayzone.

Q. How do we view information on the Grayzone website when all we have is the consumers "T" number?
A. Only social security numbers can be used on the Grayzone website.

Q. Does the provider have to call to have the consumer re-certified?
A. Not if the consumer is already enrolled.

Q. How can we verify that the 'pharmacy only' is active?
A. Verify through EVS.

Q. Who should we contact if EVS gives incorrect information?
A. The information in EVS is governed by the state; you should contact Medicaid.

Q. If the consumer leaves the facility does the provider have to re-certify the consumer?
A. If the consumer is "grand-fathered in" they would remain eligible until 6/30/03.

Q. For PRP and RRP services, does a treatment plan have to be submitted?
A. No, however, a copy of the plan must be kept in the consumers file.

Q. Is a DJJ (Department of Juvenile Justice) consumer who is released from an RTC considered a conditional release?
A. No, a child will return to the parent's insurance once the court order has been satisfied. If the consumer has turned eighteen, he/she should begin the process of applying to Medicaid or registering for Grayzone.

Q. If a consumer's status changes, can their coverage be retroactive?
A. Medicaid can retro activate a consumer's eligibility. MAPS-MD will review the medical records for possible retro authorization.

Q. Upon admit/ date of service the consumer is Grayzone and the $2.00 co-pay has been taken. The consumer then receives retro eligibility, how is the co-pay previously taken handled?
A. It is the responsibility of the provider to refund any co-pay amount received from the consumer.

Q. If you disagree with the amount of the grant fund, whom should you call?
A. Contact your Core Services Agency.

Billing - HCFA and UB92

Q. Is box 17 on the HCFA a required field?
A. No

Q. Is the prior authorization field still required?
A. This was never a required field.

Q. Is a modifier required for children receiving med checks?
A. Yes, please refer to your modifier chart. This is available on the website if you do not have a current one.

Q. Do all CPT codes require a modifier?
A. No, however you should check the modifier list to verify that the CPT code you are billing does/ does not require one.

Q. If a consumers' primary insurance denies for lack of authorization, will MAPS-MD also deny the claim?
A. MAPS-MD follows the guidelines set from the primary carrier in this type of denial. If the service was required to be pre-authorized and the provider fails to adhere to the requirement, MAPS-MD will deny the claim for the same reason. MAPS-MD requires that all levels of appeal to the primary insurance carrier be filed.

Q. If a child is in foster care are they still covered under the parents commercial insurance?
A. If a parent carries commercial insurance and the court orders that the parent maintains coverage for the child, Medicaid will be the secondary insurance.

Q. Is it helpful to send a copy of the authorization letter with the claim?
A. No. This will not expedite payment nor insure that the claim will be paid.

Q. Is it mandatory to put the consumer's address on the claim?
A. Yes.

Q. Is a password required for the MAPS-MD website.
A. No, www.mdhp.com does not require a password.

Q. What is the revenue code for interdisciplinary treatment planning?
A. 899

Q. CPT codes 99281-99285 have no corresponding revenue codes. Why is that?
A. 99281-99285 are professional fees and must be billed on a HCFA 1500.

Q. What is the expected turn around time for appeals?
A. 30 days.

Q. What will happen if you bill a claim without breaking out the non-covered charges?
A. The claim will either be denied or returned to the provider.

Q. What is the difference between EX code 45 and 90?
A. EX code 45 is an exact duplicate of a previously paid claim. EX code 90 is a possible duplicate of another claim in the system.

MAPS-MD Provider Updates

Please take a moment to review your current provider information on our website under "Provider Directory". If there are corrections that need to be made or if there are any recent changes to your provider information e.g., if you are adding a new location, telephone number, etc please fill out the attached PAR (Provider Action Request) form and fax to the attention of Jeff Zang, Provider Relations @ 410/953-1857.

Previous Issues Bulletins