From the Mental Hygiene Administration (MHA) to All Providers:

Waivers of Pre-authorization and Timely Filing Requirements

Unless, the Provider proves that failure to meet the requirements stated below was solely due to actions by MHA/MAPS-MD or its agents, pre-authorization and timely filing requirements will not be waived.

COMAR 10.09.36.06 states: The Department may not reimburse the claims received by the Program for payment more than 9 months after the date of service.

A claim for services provided on different dates and submitted on a single form shall be paid only if the Program receives it within 9 months of the earliest date of service.

A claim which is rejected for payment due to improper completion or incomplete information shall be paid only if it is properly completed, resubmitted, and received by the Program within the original 9 month period, or within 60 days of rejection, whichever is later.

Claims submitted after the time limitations because of a retroactive eligibility determination shall be considered for payment if received by the Program within 9 months of the date on which eligibility was determined.

COMAR 10.09.59.06 Provides that a provider shall comply with the preauthorization requirements of 10.09.70.07.

Faxed Authorization Letters:

Numerous providers who have registered with MAPS-MD have not provided us with a fax number that would enable us to fax authorization letters to them. If you have recently changed your fax number we are asking that you update us.

Please send your one dedicated fax number to the attention of, Julianne Ge, at 410/953-1856 in order to receive automated faxed authorizations.

Treatment Plan Update

MAPS-MD has developed a dedicated treatment plan team who will be able to review and authorize all treatment plans submitted within 3 business days. It is important that providers fax all treatment plans accompanied with the MAPS-MD "confirmation of receipt" of treatment plan form to 410 953-1903. Treatment Plans sent to this fax number are stored in a computer and are available for retrieval if needed. Faxing to this number and using the "confirmation of receipt" of authorization plans is the only way to guarantee that treatment plans have been received by MAPS-MD. Providers who send their authorization plans via mail should also use the "confirmation of receipt" of authorization plans.

POC (Purchase of Care Services)

Because of the need for special handling of POC claims, providers who are currently submitting these claims must submit them to the attention of "Provider Relations." In order to ensure proper processing, please do not forward these claims directly to the claims department at this time.

Care Management Update

When calls regarding clinical issues are received through MAPS-MD's 800 number (800/888-1965), calls are routed to the Care Management Department: To effectively respond to provider requests and to ensure greater efficiency in service, please choose from the following options:

Grayzone Grant Funding/Retro Eligibility Claims

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

• Authorization will be required on the date that you contact MAPS-MD for authorization
• 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.
• Please resubmit claims that deny for legitimate errors, (e.g., social security, membership,etc..)
• Claims must be processed as 8G 's in order for claims to count against the grant funding

Friendly Reminders

Necessary information needed when calling MAPS-MD to register a patient, conduct a review, or to check claims status:

• Provider's Identification number, (This is the Provider's Medicaid Number, not the Tax Id number)
• Please Note: MAPS-MD relies on the information you give us when registering patients for care. Without the appropriate provider identification number, patient authorization could be inadvertently placed under the incorrect provider identification number.
• Patient's Name
• Medical Assistance Number or Social Security number
• Patient's Date of Birth.

Claims Address:

Effective June 1, 2002, all MAPS-MD claims should be sent to the following address:

Maryland Health Partners Provider Training Needs Survey

Opportunity for Input

MAPS-MD provides training for providers and their staff about its administrative services and the public mental health system. MAPS-MD currently offers the following resources for information and training:

• Monthly Provider Bulletins
• Yearly regional provider trainings
• Provider Manual (online)

• Training Needs Survey (word document)   Once you've completed it: Save it to your computer Click on this link: MAPS-MDSurvey@apshealthcare.com Select Insert>File Navigate to the saved survey on your computer and click OK Click Send! Alternatively, you can fax it to us at 410/953-1856 ATTN: M. Fuller

  Customized training on request

MAPS-MD wants to know how we can best support

your needs for training and up-to-date information. We continuously revise our provider training materials and want your input on what you and your staff need to know about our services and the public mental health system.

We appreciate your ideas and input! Just download this Provider Training Needs Survey, complete it and return it  to us by one of the following methods:

• email the completed survey as an attachment to: MAPS-MDSurvey@apshealthcare.com

OR

• fax the completed survey to 410/953-1856 ATTN: M. Fuller

We'll incorporate your responses into our training materials as we update them. Thanks!

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.

HIPAA Update

Maryland Health Partners has presented its plan of action to DHMH and MHA to comply with HIPAA requirements for Transactions and Code Sets, Privacy and Security. Final HIPAA compliant Transactions and Code sets have been issued; compliance will be monitored by the Centers for Medicare and Medicaid Services. These codes include ICD-9, CPT, HCPCS, modifiers, place of service, type of bill and revenue codes. Use of standard code sets must be in place by October 16, 2003.

MAPS-MD currently requires the use of non-standard modifiers and local codes ("W" codes) for the pricing of claims. MAPS-MD, Maryland Medicaid, and MHA are working to map the local codes to new industry standard codes and to eliminate the non-standard modifiers and replacing them with CPT codes. (Please access APS healthcareProvider.com for more information regarding Universal code sets and the PMHS.) In addition, MAPS-MD is working with WebMD on the standardization of transactions. Tentatively, providers can expect to receive new rates in March 2003.

Regarding HIPAA Privacy standards: MAPS-MD reminds you 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 for this information.

Tentatively provider trainings regarding HIPAA are scheduled for May 2003 once coding sets have been finalized by MAPS-MD and MHA.

MAPS-MD will keep you informed of progress on this HIPAA plan, and providers will receive notice prior to the implementation of any changes related to HIPAA. As providers, please keep in mind that you are obligated to make available notice of your provider practices to those you serve. The deadline for meeting this requirement is April 14, 2003. www.HHS.GOV/OCR/HIPAA/PRIVACY.HTML

Please reference this additional web site for further information regarding HIPAA:

www.mhcc.state.md.us (Please refer to the HIPAA related links when accessing this web site)

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