Transcription of 2021 Maryland Medical Assistance Program Professional ...
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2021 Maryland Medical Assistance Program Professional ...
2021 Maryland Medical Assistance Program Professional Services provider manual Effective January 2021 Professional Services provider manual Maryland Medical Assistance Program 2 TABLE OF CONTENTS CHAPTER 1: INTRODUCTION TO THE manual A. INTRODUCTION 5 B. BACKGROUND 5 C. LEGAL AUTHORITY 6 D. DEFINITIONS 6 CHAPTER 2: GENERAL INFORMATION A. INTRODUCTION 12 B. FEDERAL GUIDELINES 12 i. Medicare 12 ii. Free Care Policy 12 iii. HIPAA and HCPCS 12 iv. NPI 13 v. provider Verification System (PVS) 14 vi. NCCI 15 C. COVERAGE 15 i. Covered Services 15 ii. Services Not Covered 17 iii. Coverage Determination Requests 19 D. PAYMENT 19 i. Professional Services 19 ii. Payment in Full and Maximum Payment 20 iii. Third Party Recoveries 21 E. CODING AND BILLING 21 i.
Professional Services Provider Manual Maryland Medical Assistance Program 2 TABLE OF CONTENTS CHAPTER 1: INTRODUCTION TO THE MANUAL A. INTRODUCTION 5 B. BACKGROUND 5 C. LEGAL AUTHORITY 6 D. DEFINITIONS 6 CHAPTER 2: GENERAL INFORMATION A. INTRODUCTION 12 B. FEDERAL GUIDELINES 12 i. Medicare 12 ii. Free …
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