New Provider Relations Manager

MAPS-MD welcomes our new Manager of Provider Relations, Patricia Stuehler. Ms. Stuehler formerly was a manager with Aetna, Inc., working on claims, quality, and cost management issues. She has held previous positions with the provider community, including Patuxent Medical Group and Park Circle Medical Associates as well as DHMH. Ms. Stuehler is looking forward to working with the mental health community and helping you with any issues that arise.

Former Provider Relations Manager Mel Fuller has chosen to pursue other career opportunities in health care. Her last day with MAPS-MD was April 8, 2003. The entire MAPS-MD staff wishes Ms. Fuller much success in her future professional endeavors.

Retro Eligibility Claims/Gray Zone Grant Funding

MAPS-MD has begun processing the retro Medicaid claims from July 1t to March 31, 2003. Please keep in mind the following:

• We do not require authorization for Gray Zone claims since they are grant funded. However, if a patient obtains Medicaid eligibility, then you need to get authorization from the date the eligibility is posted in the EVS system. Please remember to check EVS prior to rendering services to verify whether the patient is Medicaid eligible or Gray Zone.
• MAPS-MD will give retro authorizations for consumers who meet the medically necessary criteria only.
• Claims submitted for the grant program and subsequently denied will not be counted toward your grant totals used by your CSA. Therefore, it is imperative that these claims are corrected and resubmitted as soon as possible.
• Payment of these claims will be for the retro eligibility period only.
• Please resubmit claims that deny for legitimate errors (e.g., social security, membership, etc.) with the necessary information.
• Grant-funded claims are processed in a fashion similar to other claims. They do not require authorization but specific benefit rules apply. When claims pass certain edits in our claims system they are adjudicated and the EOP shows $0.00 payment, not the amount allowed by the Medicaid fee schedule. In order to prevent confusion, a special explanation code is used (8G) to indicate that the $0.00 payment is the result of the grant-funded benefit.

Claims must be processed as 8G 's in order for claims to count against the grant funding.

Claims Update

To ensure proper processing, please submit all claims that have attachments on paper. (Please do not bill these claims electronically.) These would include claims for the DJJ (Department of Juvenile Justice), Medicare Crossover claims, as well as any additional claims that require the submission of attachment.

Commercial Lab Claims

The referring physician name and MA number should be entered on Box 17 of the HCFA-1500 for commercial lab claims. Only physicians (MD, DO) with a valid Medicaid provider number may order lab services. This is a federal requirement. A retraction of payments, going back to July 1, 2002, will be made for claims that have been paid without correct completion of Box 17.

HIPAA Update

Standards for Privacy of Individually Identifiable Health Information: Effective April 14, 2003

MAPS-MD has been actively preparing for the April 14 deadline for compliance with the Privacy Rule. All MAPS-MD staff have been trained on the Privacy Rule and updated procedures related to the privacy standards.

Please remember to use our secure fax number, (410) 953-1903, when faxing treatment plans to our office. This fax machine is located in a secure area and allows MAPS-MD to comply with privacy requirements of HIPAA.

Notice of Privacy Practices have been distributed to PMHS consumers by the DHMH for Medicaid recipients and by MAPS-MD on behalf of the MHA for the uninsured. You may find a copy of the notice on the DHMH website and any subsequent revisions:

http://www.dhmh.state.md.us/html/privacystatement.htm

MHA is nearing completion of its review of the Transaction and Code Sets. Provider training regarding HIPAA and the Billing of Claims is scheduled for June, 2003. This is contingent upon finalization of the codes by MAPS-MD and MHA. MAPS-MD will keep you informed of progress in this area. We will send all providers notice prior to the implementation of any changes related to HIPAA.

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