Dated: February 21, 2003

From: Brian Hepburn, Interim Executive Director, MHA

To: All Psychiatric Rehabilitation Program (PRP) Directors:

This communication is to provide clarity regarding the issue of summer camp. After considerable discussion with local Core Service Agency (CSA) directors, and in conjunction with a review of current Public Mental Health System's (PMHS) policy and guidelines, it is evident that summer camp is not a reimbursable service within the PMHS.

However, this is to be distinguished from psychiatric rehabilitation services that are medically necessary and occur over the summer months. For example, children and adolescents who have been receiving PRP services during the school year may continue to need support during the summer. For children needing these services during the summer months, Maryland Health Partners should be contacted for a medical necessity review.

PRP services during the summer months, must meet Medical Necessity Criteria, and must be preauthorized in the same way as PRP services are authorized throughout the year in order to be reimbursed.

Please contact your local CSA director if you have questions regarding this policy.

Psychological Testing

If you have questions or concerns regarding psychological testing please contact Nicole Mullen at 410-953-1883.

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 please take the time to update us.

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

Treatment Plan Update

MAPS-MD has developed a dedicated treatment plan team who will be able to review and authorize all completed 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 claims directly to the claims department. Doing so may result in your claims being denied for no authorization.

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 February 28, 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..)
• 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 paid but paid at $0.00 rather than according to 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.

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:

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 healthcare.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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