| Claims Courier—
There have been improvements to MAPS-MD’s
online provider claims submission tool since mid-June.
Now, when creating a claim online, a provider only needs
to enter a member’s demographic information one
time. When submitting subsequent claims for that member,
the provider now only has to retrieve the prior claim
and modify the time period, along with any other factors
that might have changed since the provider last submitted
a claim for the member.
If you are a provider submitting a small number of
paper claims, especially handwritten claims, you may
find this a good option for you to obtain faster turnaround
time on claims. Check it out at www.apshealthcare.com
if you have signed up or go to the forms section of
this website to obtain the Provider
Agreement so you can sign up.
EVS—
As a reminder, please EVS your consumers on a regular
basis. Consumers may lose eligibility and it is your
responsibility to monitor their situation or you run
the risk of not being paid for your services.
EOP’s
Some providers experienced EOP’s with horizontal
and vertical totals that did not add up properly. The
subtotals were correct and the check amounts were accurate.
The EOP file was dropping one of the lines from EOP
when there was a “split” claim, i.e. when
a portion of the payment was applied to a negative balance.
You can identify this problem when the Allowed less
the Other Payments does not equal the Payment Amount.
Going forward, the EOP has been modified to include
both lines. However, you should note that the charge
will be repeated twice so that both of the lines in
the “split” claim print. Again, the Allowed
less the Other Payments will not equal the Payment Amount
on the same line. However, the Allowed (from one line
only) less the Other Payments will equal the Payment
Amounts from both rows and the payments from all lines
will equal the payment subtotal. The Charges, Allowed
and Other Payment subtotals will be overstated since
the line is being printed twice.
Examples:
Old |
|
|
Procedure |
Charge |
Allowed |
Other
Payment |
Co-Pay |
Payment |
|
04/28/04 |
90853
|
$50.00 |
$34.00 |
$0.00
|
$0.00 |
$21.00 |
| |
sub-total |
$34.00 |
|
New |
|
|
Procedure |
Charge |
Allowed |
Other
Payment |
Co-Pay |
Payment |
04/28/04 |
90853 |
$50.00 |
$34.00 |
$0.00
|
$0.00 |
$21.00 |
|
04/28/04 |
90853
|
$50.00 |
$34.00 |
$0.00
|
$0.00 |
$13.00 |
|
subtotal |
$100.00 |
$68.00
|
$0.00 |
$0.00
|
$34.00 |
|
Fiscal Year End Claims
Providers should split bill all inpatient claims, including
those with DRG’s that span the State’s fiscal
year end, i.e., June 30, 2004.
Print a copy of the Bulletin
 Adobe
Reader is required to view PDF files.
|
