From: Timothy Santoni, Deputy 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.

Extension Under HIPAA

If you are a covered entity and will not be compliant with the HIPAA Electronic Health Care Transactions and Code Sets standards by October 16, 2002, you must file a compliance plan. You do not have to file a compliance plan if you will be compliant by October 16, 2002 but one or more of your trading partners is not yet HIPAA compliant. You/your organization must be HIPAA compliant by this date (or by October 16, 2003) if you are filing a compliance plan for all transactions that apply to you. (Reprinted from The Centers for Medicare and Medicaid Services Website)

HIPAA extension forms are available for completing on-line and also for Downloading (for paper submission) at:http://www.cms.gov/hipaa/hipaa2/ascaform.asp

In order to receive a one-year extension (October 2003) for compliance as provided by the Administrative Simplification Compliance Act, completed forms must be received by October 16, 2002.

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

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.

Tips for Conducting Pre-authorizations for Clinical Services

Please have the following information readily available for review/discussion when contacting MAPS-MD:

• Diagnosis: Axis 1-5
• Presenting Problem:
• Why now?
• Developmental issues:
• Intellectual issues:
• Mental Status:
• Psych. History
• Hx of Abuse/Neglect
• Risk Assessment
• Medications/ Compliance
• Medical History
• Chemical Dependency:
• Specific substances
• Last use; tox screen
• Treatment
• Withdrawal present/anticipated?
• Legal Issues
• Social Supports/Living Situation
• Plan of Treatment/Goals
• Discharge Plan

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 persons name must match with what we have on file.

WEB Sites:

GrayZone/Auth. HTTP://WWW.GZMD.COM/ (same Web address, different logins)

General Information HTTP://WWW.MAPS-MD.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. For help, we offer you the following documents:

A Letter from the Director

FAQ

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. Clean claims processed electronically are generally processed within 5-7 days.

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