Provider Training 2002 Scheduled for September

Please mark your calendar to attend these important training sessions. The first half of training will focus on recent changes in the PMHS, the clinical authorization process, and issues surrounding clinical policies and procedures. The second half will focus primarily on billing issues including common Q&A regarding membership and billing, how to complete HCFA and UB92 claim forms, as well as the electronic claims process.

MAPS-MD System Migration

Maryland Health Partners is in the process of migrating to a new integrated claims and clinical system. This change will enhance the claims payment to our providers and should 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 consumer's 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.

Changes to 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 A001

Tips for Conducting Preauthorizations 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
  

Website Information

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

Timely Filing/Claims 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)

Third Appeal:

Please submit the third appeal along with the two denial appeal letters from MAPS-MD to the Mental Hygiene Administration (MHA) at the address listed below:

Final Appeal:

Final appeals go to the Office of Administrative Hearings through the Mental Hygiene Administration.

(Please note that this does not replace the clinical appeals process)

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 the MMIS II system.

In the case of hospital claims, a request for retrospective authorization along with appropriate documentation (medical records) 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.

When resubmitting claims for retro eligibility please have each claim stamped "retro eligibility claim" . This will assist our processors in identifying these claims and help to eliminate erroneously denied claims.

UB Billing Update

Recently, there have been some providers who have been unable to successfully transmit UB92 claims electronically due to technically problems relating to the occurrence code. This problem has now been revolved. Any provider who has been affected by this problem can now resume electronic transmission of their UB92 claims. Thank you for your patience.

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. Claims processed electronically are generally processed within 5-7 days.

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