Important information for Maryland Medicaid providers in prep for January 1, 2014. Please read our Message to Maryland Medicaid providers to learn what you can expect as we launch the Medicaid expansion on January 1, 2014.
Primary Adult Care (PAC) Program update. Primary Adult Care (PAC) members have full HealthChoice benefits effective January 1, 2014. New member ID cards have been processed and should be received by members the week of January 6, 2014. If services are needed prior to receiving the ID card, providers can verify eligibility using EVS using the patient’s name or Medical Assistance number. When using EVS, providers will see two entries (one for the PAC program and one for the HealthChoice program). Be sure the correct HealthChoice ID number is used to ensure proper billing and payment. Providers can also log into HealthLINK to look up members by name and/or date of birth.
McKesson ClaimCheck® software update. We currently use McKesson ClaimCheck® code auditing software to ensure correct coding and payment for our providers. By the end of 2013, this software will be updated resulting in enhanced scrutiny for submitted claims. To help our providers with this transition, we are giving them access to McKesson’s Clear Claim Connection™, a tool that will allow providers to verify correct coding prior to submitting a claim. More information on this change can be found in our Provider Notice or in the Clear Claim Connection™ Overview. For questions, please call Provider Relations at 888-895-4998.
USFHP Referral Process Streamlined. Effective December 1, 2013, we will streamline the process for the Johns Hopkins US Family Health Plan (USFHP) specialty office visits. Starting December 1, 2013, USFHP specialists will no longer need to submit a paper referral form with your claim. Again, this change only affects office visit referrals. Pre-authorization requirements remain unchanged. Primary care providers will continue to provide referrals or script detailing the specialist services needed to the USFHP plan members and specialist (no paperwork needs to be submitted to the health plan). Please continue to include the referring provider’s NPI number on the referrals. To see the notice that was mailed November 1, click here.