HIPAA Informational Requirements

We would like to bring to your attention certain data elements that will be required after October 16, 2003, under the new HIPAA requirements. These are applicable to both paper and electronic claims, but we were not capturing them heretofore under the EDI process.

HCFA 1500

Block 32 should include the Facility ID. This is the facility's Medicaid number. These facilities have billed MAPS-MD in the past and the information may or may not be completely current. For specific information on any facility, you should contact the hospital directly.

UB-92

Block 80 should include the principal procedure code and date. This is a 3 or 4 digit code that can be obtained from the ICD9-CM book. This has always been a requirement, but it will be enforced beginning October 16.

PRP Services in a Child's Home

Effective September 1, 2003, MHA has made the following clarification to Chapter 5-13 of the Provider Manual for services provided to a child or adolescent in the child's living environment:

PRP services provided in the child/adolescent's living environment, regardless of whether a family home, foster care home, group home etc, shall be billed using one of the following codes: W9500, W9501, W9506 These services should not be billed using the supported housing codes.

The supported housing rates are for PRP services provided to adults in their living environment, if provided to only 1-2 adults at a time.

Calling MAPS-MD

The Provider Relations staff at MAPS-MD is here to serve you. If we are not immediately available and you leave a message, please remember to state:

• Your name
• Name of organization
• Provider number
• Telephone number
• Clear and concise message as to why you are calling

If we have this information, we can research the request prior to calling back. If you are unavailable when we call, we can still leave a meaningful message. We can also avoid phone tag going back and forth exchanging nothing more than our phone numbers.

Clean Claims

Please do not write notes or attach notes to claims. The claims should be able to stand alone without additional information appended. There are three exceptions and these claims should be directed to P.O. Box 3190, Columbia, MD 21045-7190, Attn: Provider Relations.

The exceptions are:

• Retro Medical Assistance
• Purchase of Care
• Corrected HCFA Claims
  

Occurrence Span Codes

The Maryland Medicaid Manual requires that Occurrence Span Codes (Blocks 32-36) and dates be used to define a specific event.

Example: Code 69 indicates that the consumer is institutionalized by court order. The dates should be included as MMDDYY and both the beginning and ending dates should be shown. For occurrence code 69, the occurrence span period would be the statement period.

Revenue Codes 760, 761, 769

The Revenue Codes 760, 761, 769, Outpatient Treatment Room, are not covered under the Public Mental Health System on inpatient claims. If these codes are submitted, they will be paid at $0.00. If the patient has used the services included in the codes and is admitted to the hospital, only the inpatient room and board code will pay.

If the provider has been paid for these codes in the past, the funds will be retracted.

Revenue Code 762

Revenue Code 762 is payable for service dates beginning July 1, 1999, on inpatient claims when the following condition is met:

The observation room RVU's can be added to a patient's bill after two hours following an initial documented physician evaluation with a corresponding order by a physician not to admit but to observe the patient in the Emergency Department. (Source: MMA Hospital Transmittal No. 170, October 5, 1999)

Please refer to the transmittal for specific details if you have questions.

Retractions

The State of Maryland has the authority to make retractions against claims going back to the beginning of the Public Mental Health Program. The various State laws restricting the time in which retractions may be made are not applicable in this area.

The normal process by which retractions occurs is as follows:

1. MAPS-MD notifies provider that a retraction will be made in 30 days unless the provider supplies information indicating that the retraction is not warranted. This notification contains specific information on the patients, dates of service, and reasons for the retraction.
2. If the decision is made to move forward, MAPS-MD makes the retraction. The actual recovery of the funds owed by the provider occurs on the EOP. The recovery is made against current payments. The EOP will indicate that specific consumer on the EOP is paid. However, actual dollars may not be on the check for that particular consumer because the retraction for a payment made on an earlier EOP is now being taken back. The retractions on the current EOP continue until the "negative balance" (or amount owed by the provider) is recovered by MAPS-MD.

Since many providers have had difficulty with this process, we would like to suggest the following approach.

1. Maintain your records-You need to retain the original notification of retraction, the Negative Balance Report, and the EOP on which the retraction occurred. While it is possible for Customer Service to recover an EOP or Negative Balance Report, it is your responsibility to maintain the records. It is very time consuming to run these reports. Requests for duplicates should be rare.
2. Be proactive-If you wish to dispute the retraction, present your information within 30 days to MAPS-MD as set forth in the retraction notice. Retractions may occur several times a year and it is incumbent that you resolve (agree or dispute) within the initial 30 days. We are getting calls on issues going back several years. It is very difficult to try to reconcile after such a time lag, after potentially several retraction notices, and with inadequate record keeping on the part of some providers.
3. Call Customer Service at 1-800-888-1965 if you have questions. That should be the initial point of contact. If you need to discuss the issue in more depth than Customer Service can provide, please present your questions and issues in writing to the Retraction Unit.
4. Research Process
• Negative Balance Report-The column entitled "Date Paid" indicates the date of the EOP on which the retraction took place. The column entitled "YMD Eff" is the date of service.
• EOP-The EOP indicates the accounts being retracted and the reason for the retraction.
5. Reconcile your accounts-Please post all payments and retractions on the EOP to your Accounts Receivable.
• Debit the retraction, which will leave a balance due.
• Credit the payment, even in situations when no actual cash payment has been made, since MAPS-MD has paid the claim.
• Be careful to credit the correct dates of service in these and all other payment posting situations or it will be difficult to reconcile at later dates.
  

Federally Qualified Health Centers

Effective 7-1-03, FQHC's should use procedure code T1015 to bill for services now being billed using procedure code M0008. The per-visit reimbursement rate for T1015 is the same as that for M0008. If you have not billed services for dates prior to July 1, 2003, you should continue to use M0008 for those dates. (Source: MMA Clinical Transmittal No. 57, June 19, 2003)

When billing procedure code T1015, you must also complete the Medical Management Form and send it both to MAPS-MD to register the patient and to the consumer's PCP, presumably a somatic physician internal to the FQHC. Authorizations are no longer required for the first 12 visits, consistent with the policy for procedure codes 90805 and 90862. For a further discussion of this form, please refer to the July 2003 Bulletin.

Inpatient Bill Audits

MHA has advised providers in a special mailing that it has authorized Integrated Healthcare Auditing and Services (IHAS) to perform inpatient bill audits for MAPS-MD. Please review the full letter.

New Check Production and Mailing Procedure

The following information from Dr. Brian Hepburn, Interim Executive Director, Mental Hygiene Administration, was conveyed to providers in a separate mailing on July 22, 2003, and is repeated here for future reference:


"On [or about] September 1, 2003, checks for services rendered in the Public Mental Health System (PMHS) will no longer be prepared and mailed by Maryland Health Partners (MAPS-MD). MAPS-MD will continue to authorize services and receive and process claims and send Explanation of Payments to providers. They will also prepare a file which contains information regarding the checks to be sent based on claims processing. The file will be sent to the Comptroller whose office will prepare and send checks.

This change in procedure has several implications for the provider community. First, the number on the check that the provider receives will no longer match the number associated with the EOP. MAPS-MD will continue to print an invoice number on each set of claims processed for each provider. This invoice number will be forwarded to the Comptroller and will be placed on the check. The sequential check number, however, will be unrelated to the EOP; only the invoice number in the memo field will relate the check to the EOP.

A second concern will arise if the Comptroller has a record that a provider owes money to the State of Maryland for any reason, including delinquent taxes. This does not include sums for which a payment arrangement has been made with either MHA or with Central Collections. In all other cases, funds requested for that provider will be withheld by the Comptroller and credited to the delinquent account. Neither MAPS-MD nor the Mental Hygiene Administration will have any knowledge that this has happened, nor will they have the ability to prevent this from occurring. The provider will be notified by the Comptroller's office that the funds were earned but retained and credited to the balance which was owed to the State. It is therefore essential that any provider that currently owes a debt to the State of Maryland settle this issue prior to the implementation of the new system.

One of the benefits of having funds remitted directly by the Comptroller is that providers may sign up for Automated Clearinghouse (ACH) funds transfers. However, it is essential that prior to signing up for this option, providers be aware of certain implications for their own record keeping. While payment checks will continue to be prepared for each Medical Assistance provider number, only one ACH transfer per batch will be made for each Tax Identification Number (TIN). Thus, if a provider has several provider numbers but a single TIN, and funds are due to several of the provider numbers in a given batch, a single transfer will be made to the provider based on the TIN. It will be incumbent upon the provider to apportion those funds to the appropriate sub-agencies based upon the EOPs which the providers have received from MAPS-MD.

While providers may obtain the contacts necessary to get the forms needed to sign up for ACH transfers at the Comptroller's Web Site, (see: http://business.marylandtaxes.com/paymentinfo/eftprogram/overview.asp and http://business.marylandtaxes.com/paymentinfo/eftprogram/statecontact.asp) it is essential that providers notify MAPS-MD's Office of Provider Relations (410-953-1800 ) once the Comptroller indicates that they have been approved for such funds transfers. [A direct contact is La'Kashia Godfrey, 410-953-1837.] Once a provider has registered for and been identified as a recipient of ACH transfers in the Comptroller's files, MAPS-MD must make adjustments to the request that it submits to the Comptroller. If MAPS-MD does not identify all providers who are registered for ACH transfers in its submission, the entire submission will reject. This will require action by MHA and MAPS-MD to correct the submission prior to any payments being made. This means that payments to ALL providers will be delayed. This is not an event which any of the participants in the process, least of all the providers, want to occur. Therefore, once any provider has applied for ACH transfers from the Comptroller and that application has been approved, it is essential that the provider notify MAPS-MD of this change.

Finally, there are issues regarding whom providers should contact if issues arise. Please do NOT contact the Office of the Comptroller to make inquiries or report problems. Issues regarding claims processing or claims denial should continue to be directed to the MAPS-MD claims line (1-800-565-9688). Any problems with check amounts or questions regarding check production should be referred to the Mental Hygiene Administration at 410-402-8440. Again, it is essential that providers do not attempt to contact the Office of the Comptroller for any issues regarding this process.

Your continuing cooperation in this and all other matters is appreciated, as are your continued efforts on behalf of Maryland Citizens with mental illness."

Print the Web Issues Bulletin (120K, estimated download time 17 seconds)

Previous Issues of the Bulletin