Maryland medicaid cms-1500 paper
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- Navigate this page:
- A Comprehensive Guide Focusing on Maryland Medicaid Billing Procedures and Other Useful Information
- Medical Care Programs TABLE OF CONTENTS I. GENERAL INFORMATION
- III. BILLING INFORMATION
- VI. FRAUD AND ABUSE
- VIII. EPSDT/HEALTHY KIDS
- IX . HEALTHY START PROGRAM FOR PREGNANT WOMEN
- XI . LABORATORY AND PATHOLOGY
- XIV. PRIVATE DUTY NURSING
- INTRODUCTION
     
MARYLAND MEDICAID CMS-1500 PAPER BILLING INSTRUCTIONS
Effective April 2013 Dept. of Health and Mental Hygiene Office of Systems, Operations & Pharmacy Medical Care Programs TABLE OF CONTENTS I. GENERAL INFORMATION PAGE A. Introduction 1 B. HIPAA 1 C. NPI 1 II. HEALTHCHOICE A. Health Choice (MCO) 2 B. Payments to Managed Care Organizations 3 C. MCO Excluded Services 4 D. Self-Referral Services 5 III. BILLING INFORMATION A. General Instructions 6 B. Timely Filing Statutes 6 C. Paper Submission & Claims Address 6 D. Electronic Submission 7 IV. EVS 8 V. CMS-1500 BILLING INSTRUCTION A. CMS-1500 Billing Instructions 10 B. Third Party Billing 18 C Medicare/Medical Assistance Crossover Claims 20 D. Claims Troubleshooting 23 E. How to File an Adjustment Request 27 F. Medical Assistance Payments 28 VI. FRAUD AND ABUSE 29 VII. MARYLAND MEDICAID PROGRAM SERVICES INFORMATION A. Emergency Service Transporter 32 VIII. EPSDT/HEALTHY KIDS A. EPSDT/Newborn Billing 33/34 B. Audiology 35 C. IEP/IFSP Health Related Services 36 D. PT, OT, Speech & Chiropractic Services 37 E. Substance Abuse Services 38 F. Therapeutic Behavioral Service 41 G. Vaccine for Children Program 42 H. Vision Care Services 43 IX. HEALTHY START PROGRAM FOR PREGNANT WOMEN 44 X. DMS/DME A. DMS/DME 45 B. Oxygen and Related Respiratory Equipment Services 46 XI. LABORATORY AND PATHOLOGY 47 XII. MEDICAL DAY CARE 48 XIII. PHYSICIANS’ SERVICES A. Physicians’ Services 49 B. Modifiers 50 C. Podiatry 53 D. Radiology 54 E. Abortion 56 F. Hysterectomy 57 G. Sterilization and Tubal Ligation 58 H. Trauma Billing 60 XIV. PRIVATE DUTY NURSING 63 XV. IMPORTANT TELEPHONE NUMBERS AND ADDRESSES
XVI. FREQUENTLY ASKED QUESTIONS 69 XVII APPENDIX – DHMH FORMS A. CMS-1500 Form 71 B. Adjustment Form - DHMH 4518A 72 C. Abortion Form - DHMH 521 73 D. Hysterectomy Form – DHMH 2990 74 E. Sterilization and Tubal Ligation Consent Form – DHMH 2989 75 INTRODUCTION This manual was prepared to provide proper billing procedures and instructions for Maryland Medicaid providers who bill using the CMS-1500 form. This includes Certified Nurse Midwives, Certified Nurse Practitioners, Certified Registered Nurse, Anesthetists, Free-Standing Clinics, Physicians, Podiatrists and DME/DMS providers. The Medical Assistance Program has made numerous revisions to the billing procedures for all Medicaid Programs in order to adhere to the standards created under the Health Insurance Portability and Accountability Act (HIPAA). As a result of the requirement for standardization of code sets and forms, Maryland Medicaid has replaced all local procedure codes to nationally accepted codes. This includes standardization in the way providers transmit claims electronically. Directory: SiteCollectionDocuments SiteCollectionDocuments -> World War One memorials in the City of Melbourne by Dr Michael Cathcart SiteCollectionDocuments -> Crossing Cultures It’s Still Everyone’s Business SiteCollectionDocuments -> Affirmative action equal opportunity policy SiteCollectionDocuments -> On appeal from the employment appeal tribunal SiteCollectionDocuments -> Student friendly course descriptions – canadian and world studies SiteCollectionDocuments -> Logged Changes in Infotype Data SiteCollectionDocuments -> For immediate release contact SiteCollectionDocuments -> Listing by Member Local Area 1 1 Members Name Benjamin Anderson Appointment Begins SiteCollectionDocuments -> Final Minutes 1500 Jefferson – Presentation Room Download 315.64 Kb. Share with your friends:
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