Disclaimer: The contents of this website and any information contained herein are intended solely for the use by providers and care coordinators and may contain confidential and/or privileged information which is legally protected from disclosure pursuant to the HIPAA and HITECH laws and/or other applicable law.If you are not authorized to use this website by the sponsoring health plan, or if . TheProvider Alertsare important updates from Optum and the Department. Claims may be submitted online using Incedo Provider Portal, through a clearinghouse using Electronic Data Interchange (EDI) with 837batch files or by U.S. Mail. Optum Maryland gives care to people served by the Maryland Department of Health (MDH), Behavioral Health Administration (BHA). The website has sections for participants and families as well as providers of mental health services. tVMvC Incedo Provider Portal (IPP): Utilizing Client-Level COVID-19 Vaccine Status Data Files. Toll-free number:1-800-888-1965, TTY 711 - Providers should press two andfollow prompts. December 2022 Provider Training Calendar. endstream endobj startxref Incedo Provider Portal is easy to use, secure and available 24/7. Please click the drop-down icon to view contact information. MDH/BHA and Optum Maryland offer education and community events. Please note that submitting inquiries to an email address not designated for a specific issue may delay a response. Below is an anticipated schedule of releases. Deaf and Hard of Hearing Virtual Stakeholder Meetings: The Policy and Procedures subcommittee of the Behavioral Health Administration will host five regional stakeholder meetings to share information on PBHS services available and to obtain input from stakeholders on how to enhance public behavioral services for individuals who are deaf and hard of hearing in Maryland. FOR ASSISTANCE. October 2022 Provider Training Calendar. hbbd```b``U i&d/#` "l.>dqA$WX2$wE4ev=$Q x Privacy Policy | Terms of Use | Site Map | Accessibility Note:Adobe Acrobat Readeris required to view and print PDFs. If Medicare benefits are exhausted or if Medicare will deny benefits for another reason, the provider must submit claims to Medicare within Medicares timely filing limits and submit the claim and Explanation of Medicare benefits (EOMB) to Optum Maryland within 12 months of date of service or 120 days from the Medicare remittance date as shown on the EOMB, whichever is later. The rate is supplied to Optum Maryland by MDH. It is the responsibility of the facility to update MDH when a rate change occurs so that claims are paid at the correct amount. Box 30532 Salt Lake City, UT 84130. Please contact the Center's Program Director if you have any questions on this initiative or the Center's resources: Kristen Beall. <>stream Optum Nondiscrimination Notice and Language Services, see here. You have the right to get help and information in your language at no cost. Reference the charts below to identify the acceptable proof of loss for claim submission based on the service type specifics. February 2020 Training Schedule. Get customer support. %PDF-1.5 % Thus, as you consider our request for the immediate replacement of Incedo and Optum's promises of future Incedo functionality, we invite you to consider these facts: Ohio. Out-of-state psychiatric hospitals are paid at a Host State Medicaid Rate. We invite you to look through this site to see the many ways we can serve you. Email: krbeall@som.umaryland.edu. Providers can choose any clearinghouse vender to submit claims using EDI. Salt Lake City, UT 84130, Optum Maryland Please enable scripts and reload this page. O4 Dynamic Alert Site Logo. Q.4 For corrected claims submission for DOS prior to date 12/29/19 submitted to Beacon, do MDH/BHA and Optum Maryland offer education and community events. Top If you are a person or a family member seeing a MDH/BHA provider, you can access relevant information with the touch of a finger: Please enable JavaScript in your browser. 0 201 W. Preston Street, Baltimore, MD 21201-2399, Community Engagement (local Health Improvement Coalitions), Kaiser Permanente MarylandHealthChoice MCO, JHHC Additional Prior AuthorizationRequirements Added to eviCore Partnership, JHHC Site of Service Policy Update EffectiveJune 15, 2022, New Preauthorization Requirements for CertainProvider-Administered Medications, neumococcal for Medicare Benefit MM12723, Medicaid Provider Guidance COVID-19 Secretary's Orders Changes, AffordableCare Act: Young Adult Insurance Coverage FAQs, AAPC Health Plan Search: Provider Manuals and Policies, Audiology, Physical Therapy, and Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Provider Manual, MDH Memo Reconciliation and Recoupment BHASO Update, 2021 MD Medicaid Medical Laboratory Fee Schedule 2.16.21, 2021 Medicaid Professional Services Fee Schedule 1.1.21 UPDATED 3.10.21, Maryland Medicaid Dental 2021 CDT Fee Schedule UPDATED 1.7.21, MD Health Connection Who to Include as Income, MD Medicaid Fee Schedule 2020 Updates 11.1.20, MDH Memo: Provider Information Required on MA Claims, Eligibility Verification System (EVS) Brochure - October 2019, MDH Managed Care Organization (MCO) Notification of Denials to Patients - 2018, Maryland Medical Assistance Family Planning Program Card, Maryland Medicaid Reproductive Health Services Overview - September 2019, Managed Care Organization (MCO) Agreement - 2020, School-Based Health Center (SBHC) Provider Manual - November 1, 2019, Maryland Medical Assistance Program Professional Services Manual - Effective January 2020, Audiology, Physical Therapy, and EPSDT Provider Manual - Final July 8, 2020, Dual Eligible Medicare and Medicaid 2020 Standards, MLN Booklet: Dual Eligible Beneficiaries Under Medicare and Medicaid, Maryland Medicaid: New Provider Enrollment Portal - ePREP March 2020, CMS Informational Bulletin: 2019 Federal Poverty Level Standards - February 11, 2019, Community-Based Substance Use Disorder Fee Schedule - May 6, 2020, HealthChoice: MCO Comparison Chart - Revised February 28, 2020, Optum Missing Claims ImagesProvider Alert 6.8.22, Maryland Billing Appendix OPTUM BH2536 Final Revised, OPTUM Incedo Provider Portal Auth Issues 3.31.22, OPTUM Management of Neg Balances Moving Forward 4.13.22, OPTUM Update of Authorization Issues in Incedo 4.7.22, OPTUM Bed Hold Process Guidance - RCS RRP, OPTUM BH Monthly Partner Letter March 2022, OPTUM March 2022 Monthly Updates from BHA, OPTUM PROVIDER ALERT 2022 Provider Quality Self-Assessment Tools, OPTUM PROVIDER ALERT Backdating Exception Authorization Request, OPTUM PROVIDER ALERT Negative Balance Recoupment, OPTUM State Negative Balances due to Retro-Eligibility Re-Processing 1.7.22, OPTUM Bed Hold Authorization Plans 1.5.22, OPTUM BHA and MDH Tobacco Control Survey 11.24.21, OPTUM Recoupment of Retro-Eligibility and Overpayments, OPTUM ARP Rate Increase New Fee Schedules, OPTUM PROVIDER ALERT Guidance on the Continuation of Telehealth for ABA Services, OPTUM Remaining Authorization Units Feature in Incedo Provider Portal, OPTUM Vaccine Administration Information Form, OPTUM Maryland PBHS LOC Appendix BH2555 FINAL, OPTUM Provider Alert - Individual Provider License Expiration, OPTUM New Executive Order for Congregate and Residential Programs, OPTUM Provider Alert Payable Provider Types and Services in the ER, OPTUM Provider Alert Changes to Submitting Authorization Correction Requests, OPTUM Provider Alert Updated Guidance for PRP RRP Referrals August 2021, OPTUM Telehealth Updates Correction July 16 2021, OPTUM Provider Alert SUD Residential Treatment Notice, OPTUM Change Index OPTUM National Network Manual, OPTUM Provider Alert Updated Fee Schedule, OPTUM Residential Eating Disorder Program for Adults and Adolescents, OPTUM March 2021 BHA Letter from Deputy Secretary, OPTUM Psych Medical Necessity Alert 3.1.2021, OPTUM Uninsured Eligibility Alert 2.26.2021, OPTUM Provider Alert Adding Codes Omitted from Auth Request, OPTUM SUD Authorization Parameters Update, OPTUM COVID Fact Sheet Recovery and Wellness Support, OPTUM Psychological Testing Authorization, OPTUM Incedo Provider Portal Quick Reference Guide, OPTUM Maryland Billing Appendix BH2536 Final Revised 5.8.20, OPTUM Reconciliation Provider Alert Memo 7.21.2020, OPTUM Reconciliation Summary Reprort 7.21.2020, OPTUM Reconciliation Survey Provider Alert 7.23.2020, OPTUM AuthorizationAlert Update - Medication Management 9.1.2020, OPTUM New Authorization Plans Provider Alert 9.1.2020, OPTUM Authorization Requests Provider Alert 9.24.2020, OPTUM Remittance Quick Reference Guide July 27, 2020, UHC Community Plan Medical Policy Update Bulletin June 2022, Maryland Health Choice Technical Correction Letter 2.7.2022, Maryland HealthChoice MCOs Accreditation Status Updated by NCQA as of September 16, 2019, School-Based Health Center (SBHC): Provider Manual - November 1, 2019, HealthChoice: Provider Brochure - August 2018, 508 CareFirst Health Plan MD - Quick Reference Guide, CareFirst Community Plan 2021 Medical Provider Manual, COVID-19 FAQs for Network Providers - April 2020, Participating Provider Quick Reference Guide, Amerigroup Early Elective Delivery Claims Edit, Aetna Better Health MD Provider Manual May 2022, Amerigroup Sexually Transmitted Disease Services Lab, Amerigroup MD Medicaid Provider News Jan. 2022, Amerigroup Medicaid Provider Newsletter Dec. 2021, Amerigroup Provider Newsletter January 2021, MDMA Amerigroup Provider Newsletter November 2020, Medicaid Amerigroup Provider Newsletter December 2020, Important Phone Numbers to Know - November 2019, Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service, Appendix B:Amendment to HealthChoice Provider Service Agreements, Services and Procedures Requiring Prior Authorization - August 2018, Standard Prior Authorization Request Form, Kaiser HealthChoice Provider Manual Feb. 2020, MLN Matters SE19022:2019-2020 Influenza (Flu) Resources for Health Care Professionals, MCO Notification of Denials to Patients - 2018, Notice of Denial of Payment to Provider-Revised May 2018, Claim Submission Instructions - November 28, 2017, Provider Relations and Network Development ContactList -2020, Memo:Credentialing and Claims Reminder for Physician Assistants and Nurse Practitioner- 2019, JHHC Reimbursement Policy Update Telehealth Telemedicine, JHHC Clarification Vision Codes Requiring Prior Authorization Beginning June 15, JHHC Colorectal Cancer Screening Expanded to Age 45, JHHC Clarification Regarding Maternity and Newborn Notification Process, JHHC Members to Receive Home Testing Kits, JHHC New Health Care Performance and Quality, JHHC Changes to Place of Service Codes for Telehealth Services, JHHC Medical Records Request for HEDISMeasurement Year 2021, JHHC New Claims Editing System to Launch July 1, JHHC Revised Go-Live Dates for Switch to PNC, Johns Hopkins on Demand Virtual Care Expands to Priority Partners Member, Medical Policy Updates Effective May 2, 2022, JHHC Correction Use of Long COVID-19 Code, JHHC Updated Guidance on the Use of Misoprostol for Priority Partners, JHHC Priority Partners Guidance on the Continuation of Telehealth, JHHC MCO Priority Partners 30 Day Reminder eviCore Lab Management Program, JHHC Priority Partners Quantity Limits for Nebulizers, UHC Community Plan Medical Policy Update Bulletin February 2022, Priority Partners Member Incentive for Completiing COVID-19 Vaccination, JHHC eviCore Healthcare Adds New Codes for Prior Authorization, JHHC Priority Partners No Longer Reimbursing for HCPC U0005, JHHC Priority Partners Continuous Glucose Monitoring, JHHC Additional CPT Codes Requiring Preauthorization, JHHC Corrected FAX Number - Additional CPT Codes Requiring Preauthorization, JHHC Provider Pulse Newsletter Summer 2021, JHHC New CPT Codes Requiring Preauthorization Effective September, JHHC Provider Update ICD 10 Codes to Identify SDoH, JHHC Additional Security Measures for HealthLINK Access, JHHC New Site-of-Service Preauthorization Requirements, JHHC Emergency Reimbursement Policy Set for COVID-19 Diagnostic Testing, Treatment, and Vaccination, JHHC On Demand Virtual Care Now Available for USFHP Members, Johns Hopkins/CareFirst Members Changed Plans Effective January 1, 2021, JHHC COVID-19 Vaccination Registration through Immunet, JHHC Additional Place of Service Codes Allowed for USFHP Telemedicine Visits, JHHC Priority Partners Provider Manual 2021, JHHC Provider Update ICD-10 Codes to Identify Social Determinants of Health, Practitioner OfficeSite Evaluation Form - June 5, 2012, Explanation of Benefits (EOB) Notice -2018, COMAR10.09.71.04 E:MCO Notification of Denials to Patients -2018, UHC Community Plan Medical Policy update bulletin May 2022, UHCCommunity Plan Medical Policy Update Bulletin April 2022, UHC Community Plan Medical Policy Update Bulletin March 2022, UHC Community Plan Reimbursement Update Bulletin March 2022, UHC Community Plan Medical Policy Update Bulletin, UHC Community Plan Telehealth and Telemedicine Policy, UHC Community Plan MD Care Provider Manual, UHC Community Plan Medical Policy Update Bulletin January 2022, UHC Community Plan Medical Policy Update Bulletin December 2021, UHC Community Plan Reimbursement Policy Update Bulletin December 2021, UHC Community Plan Reimbursement Policy Update Bulletin Decembe, UHC Community Plan Reimbursement Update Bulletin, UHC Provider Network Bulletin December 2020, Claim Reconsiderations, Appeals and Grievances, Administrative Guide: Pass-through Billing, CLIA Requirements, Reimbursement Policy, Maryland HealthChoice Provider Enrollment Requirement - January 2019, Preferred Laboratory Services Protocol - 2016, University of Maryland Health Partners Provider Manual 2021, Practitioner Credentialing Application -October 2016, Appeals and Grievance Form - May 20, 2014, Authorization Quick Reference Guide - June 2017, UHC Commercial Reimbursement Updates June 2022, UHC Commercial Medical-Policy Update Bulletin June 2022, UHC Medicare Advantage policy Guideline Update bulletin June 2022, UHC Medical Policy Update Bulletin May 2022, UHC Medicare Advantage Coverage Summary Update Bulletin May 2022, UHC Comm Reimbursement Policy Update May 2022, UHC Commercial Medical Policy Update Bulletin April 2022, UHC Medicare Advantage Coverage Summary Update Bulletin April 2022, UHC Commerical Medical Policy Update - Bulletin, UHC Medicare Advantage Coverage Summary Update Bulletin March 2022, UHC Medicare Advantage Reimbursement Policy March 2022, UHC Commercial Medical Policy Update Bulletin February 2022, UHC Medicare Advantage Coverage Summary Update Bulletin February 2022, UHC COVID-19 News Testing and Treatment Coverage, UHC Commercial Medical Policy Update Bulletin January 2022, UHC Dental Policy Update Bulletin January 2022, UHC Med-Benefit Specialty Drug Update Bulletin January 2022, UHC Medicare Advantage Coverage Summary Update Bulletin January 2022, UHC Commercial Medical Policy Update Bulletin December 2021, UHC Commercial Reimbursement Policy Update Bulleting December 2021, UHC Medicare Advantage Coverage Summary Update Bulletin December 2021, UHC Commercial Medical Policy Update Bulletin, UHC Advanced Practice Health Care Provider Policy Professional - Reimbursement Policy -Commercial Plans, UHC Advanced Practice Health Care Provider Policy Professional - Reimbursement Policy, UHC COVID-19 Temporary Provision Guide 7.20.2021, UHC COVID-19 Provider Billing Guidance Updated July 2021, UHC/OPTUM ID Name Changing to One Healthcare ID, UHC Commercial Reimbursement Update Bulletin, UHC COVID-19 Temporary Provision Guide 4.19.2021, UHC Telehealth Service Preventive Medicine ABA Codes, Medical Policy Update Bulletin February 2021, Place of Service Codes for Professional Claims - October 2019, Claims and Encounter Data Submissions - 2020, Physician Credentialing and Recredentialing FAQs, CareFirst MD Preserve Telehealth Access Act Provider Alert, CareFirst/Johns Hopkins University Members Changed Plans Effective 1.1.2021, CareFirst on Call: Professional Reference Card- August 2018, Member Identification Card Quick Reference Guide, Precertification Request for Authorization of Services, Professional Provider Relations Representatives, Provider Portal User Guide: Remittance/Notice of Payment, Quick Reference Guide for Health Care Professionals - May 2020, Dental and Oral Surgery Claim Documentation Guidelines - April2019, Women's Health Programs and Policies - April 2019, Delegation Provider Guide - February 2020, Provider and Facility Participation Criteria - 2019, Better Health of Maryland:Provider Guide - March 5, 2019, JHHC Reimbursement Policy update Telehealth Telemedicine, JHHC Gender Affirming Procedures and Treatment Medical Policy, JHHC Reminder New Claims Editing System to Launch July 1, JHHC eviCore Laboratory Management Program for Johns Hopkins Advantage MD, JHHC New CPT Codes Requiring Prior Authorization Effective July 15, 2022, JHHC Medical Records Request for HEDIS Measurement Year 2021, JHHC New CPT Codes Requiring Prior Authorization, JHHC Federal Transparency in Coverage Rules Now in Effect for Johns Hopkins EHP, JHHC Reminder - Please Use Correct Address, JHHC COVID-19 Reimbursement Policy Update, JHHC Medical Policy Updates Effective February 2022, JHHC New Prior Authorization Requirements, JHHC Reminder of Utilization Management Processes in Light of Recent COVID Surge, JHHC Temporary Revisions of Utilization Management, JHHC Updated Reimbursement Guidance for CPT 99072, JHHC - USFHP Low Back Pain Imaging Policy - Post Service Claim Review, JHHC Service Area Changes for Advantage MD, JHHC Provider Notice ABA No Longer Covered as a Telehealth Visit for USFHP, Advantage MD (PPO) Benefits Comparison Chart - 2020, Advantage MD (HMO) Quick Reference Guide - 2020, Advantage MD (PPO) Quick Reference Guide - 2020, JHHC Provider Update Cigna PPO to Provide National Network for Johns Hopkins EHP, Medical RecordDocumentation Standards - 2017, Cigna Medicare Advantage Provider Manual 2021, Cigna Key COVID-19 Updates for September 2021, Cigna Transformations COVID 19 Interim Guidance for Behavioral Providers, Cigna COVID-19 Vaccine Reimbursement Flyer, Coronavirus(COVID-19) Interim Billing Guidance for Commercial Customers - April 9, 2020, Medicare Advantage Provider Quick Reference Guide - 2020, COVID-19 Information for Dental Providers, Medicare Advantage: Health Care Professional Provider Manual - 2020, A Guide to Cigna's Preventive Health Coverage for Health Care Professionals, Request for Health Care Professional Payment Review, MM12427 Matters New Modifications to the POS for Telehealth, Medicare COVID-19 Vaccine Shot Payment CMS, Medicare Screening PapPelvic Examinations Revised, MM12723 Revisions Medicare Part B Coverage of Pneumococcal Vaccinations, CMS MLN Matters Mental Health Visits viaTelecommunications for Rural Health May 2022, CMS Unveils More User-Friendly MedicareWebsite CMS, CMS COVID-19 New Codes for Moderna Vaccine Booster Doses, Medicare Part D Vaccines and Vaccine Administration, Medicare Vaccine Coverage Part B vs. Part D, CMS MM12676 Remittance Advice Remark Code (RARC) Claims Adjustment Code (CARC), Medicare Remit Easy Print (MPREP), CMS MM12578 Medicare Severity - COVID Diagnosis Related Group, CMS Announcement ICD 10 MS DRGs V39.1 New Procedure Codes, CMS COVID-19 New HCPT Codes for Remdesivir MLN Jan. 7 2022, CMS MLN 006818 2021 12 Clinical Laboratory Fee Schedule 508, CMS Summary of Policies Medicare Physician Fee Schedule MM12519, CMS Clinical Laboratory Fee Schedule CY 2022 Final Payment Determinations, CMS Consolidated Appropriations Act of 2021 Provider Requirements and Resources, CMS Implementation Changes End-Stage Renal Disease MM12499, CMS Home Health Prospective Payment System Rate Update MM12509, CMS Public Health Service Act Provider and Facility Requirements Presentation, COVID Vaccine Changes for Medicare Advantage Plans, Medicare Billing for COVID-19 Vaccine Shot Administration, MLN New Modification of POS Codes for Telehealth, CMS - Pneumococcal Conjugate Vaccine Coverage, Medicare Vision Services Fact Sheet Updated, CMS Monoclonal Antibody Coverage Infographic, CMS Health Care Code Sets ICD 10 MLN Fact Sheet, CMS Medical Record Maintenance & Access Requirements, CMS COVID Toolkit on COVID-19 Vaccine: Health Insurance Issuers and Medicare Advantage Plans, CMS COVID-19 Frequently Asked Questions on Medicare Fee-for-Services (FFS) Billing, CMS MLN Medicare Response to the Public Health Emergency on the Coronavirus (COVID-19), CMS Medicare Monoclonal AB COVID Program Instruction, CMS Office Based Opioid (OUD) Tx Billing 2020, Medicare Eligibility Verification FACs 9.2020, Medicare Self-Service Tools and Hyperlinks 9.2020, New Medicare Card Information - April 2018, Medicare Claims Processing Manual - September 6, 2019, MLN ICN903764: PECOS for Physician and Non-Physician Practitioners - August 2016, MLN Matters: Articles on Medicare-Covered Preventive Services - December 2018, Remittance Advice Information: An Overview - 2016, Medicare and Other Health Benefits: Your Guide toWho Pays First - 2015, MLN: Advance Beneficiary Notice (ABN) - October 2015, Advance Beneficiary Notice of Noncoverage (ABN) Form - 2020, Form Instructions: Advance Beneficiary Notice of Noncoverage (ABN), Sample Lab Advance Beneficiary Notice on Noncoverage (ABN), Avoiding Medicare Fraud and Abuse: A Roadmap for Physicians - August 2016, MLN Booklet: Annual Wellness Visit - August 2018, MLN Booklet: Medicare and Medicaid Basics - July 2018, FAQs About Billing Medicare for Behavioral Health Integration (BHI) Services - April 17, 2018, MLN Matters: ICD-10 and Other Coding Revisions to the National Coverage Determinations (NCDs) - 2019, MLN Booklet: Dual Eligible Beneficiaries Under Medicare and Medicaid - May 2018, MLN Matters: Medicare Claims Processing Manual, Chapter 30 Revisions - April 15, 2019, MLN Factsheet: Medicare Part D Vaccines and Vaccine Administration - January 2018, MLN Booklet: Mass Immunizers and Roster Billing for Influenza Virus and Pneumococcal Vaccinations - July 2018, List of Medicare Telehealth Services CY 2018 and 2019, MLN Poster: Medicare Preventive Services - August 2018, MLN Booklet: Remittance Advice (RA) Information - An Overview October 2018, CMS Memo: Ten Opportunities to Better Serve Individuals Dually Elegible for Medicaid and Medicare - December 19, 2018, MLN Matters: Guidance on Coding and Billing Date of Service on Professional Claims - February 1, 2019, Medicare Advantage and Other Medicare Health Plans - 2020. 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