The Facility Files
NPI 1740745694 (1119 E Monument St) for MD000015157, MH PHP
Code PPA, Yes
90837 GT, FMDC
Ind Psychotherapy (60 mins), Telehealth
Covered
Auth Required
No limits
MH/SUD/GAM
040325- 4065- 51
Services before/after member effective date
Provider 1538120613 performing 99213, in a community setting
$133.26
What is our electronic payor ID?
BHOMD
1578057899 (44 N Potomac St, SUD IOP for adults, FMDC)
YES (ICA)
99215, SDUA
Med Eval/Mgmt with Individual Psychotherapy
Covered
No Auth
No Limits
MH/SUD/GAM DX
031125- 9803- 482
Not covered due to DX
An LPC performs service 90846
Family Psychotherapy Patient Present, $85.29
What are the 3 possible statuses for claims?
Open, Adjudicated, Posted
NPI 1023477403 (8203 Harford Rd) for MD000015076, SUD OP
Contracted (OCA/CCA)
H2012, FDUA
ABA Treatment Planning
Yes Covered
No Auth
DX: AUT
Limits: 16 units per day, 4 hours per month
032825- 9450- 16658
GT Modifier for Psych Testing is not allowed
H2011
$115.15
What are the names of the two claim forms and what does each one report?
CMS-1500 (Professional Services)
UB-04 (Facility Services)
1578597993 (600 N Wolfe St, Inpatient Detox for adults, FMDC)
YES (ADA - shows as ADD)
99281, FSX0
Emergency Dept Visit
Yes it is Covered
No Auth
MH/SUD/POI
No Limits
Location 23: Emergency Room - Hospital
040225- 10017- 21535
Invalid Service for Vendor
H0001 GA
Alcohol and/or Drug Assessment
$179.55
NEW INFO! What is balance billing and can a Medicaid provider do this?
When the provider charges the difference between the charged amount and allowed amount back to the participant for OON benefits. NO, Medicaid providers cannot balance bill.
NPI 1578057899 (44 N Potomac St) for MD000015145, MH RTC
Would be contract if patient was eligible for services (RPA)
H2018 U5, POS 52, FMDC
On-Site PRP Services to RRP Intensive Clients
Covered
Auth Required
MH DX
1 per month
031825- 9756- 211
Psych Testing for Autism Dx not allowed
Provider 1427398783 performing 97153 for funding source SMDC
Not contracted for SMDC
Where should providers submit claims with DOS prior to 12/22/24?