Second Quarter 2016

NewsletterMaryland HealthChoice Program

The Department of Health and Mental Hygiene (DHMH) created a report card to assist enrollees in choosing a managed care organization (MCO) based on quality scores. The DHMH evaluates the activities of all MCOs contracted with the state of Maryland that provide care to medical assistance recipients in the HealthChoice program. The consumer report card has been developed from HEDIS® scores, encounter data and member satisfaction survey data. Please refer to the MedStar Family Choice website at MedStarFamilyChoice.com to view the 2015 report card and all other report cards from previous years.

2015 Consumer Report Card

Provider

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This is intended to provide you with information on laws pertaining to the prevention and detection of fraud, waste and abuse, in accordance with the requirements of the Federal Deficit Reduction Act of 2005. In addition, this article describes the procedures in place within MedStar Health and MedStar Family Choice for detecting and preventing fraud, waste and abuse. The MedStar Office of Corporate Business Integrity provides all MedStar Health facilities with compliance oversight, billing integrity support, occurrence reporting and resolution, training, and education. MedStar Health’s Internal Audit department conducts routine, independent audits of business practices and all financial managers are required to attend training on the financial manager’s code of ethics and reporting obligations. Employees, physicians, contractors, and patients are encouraged to report privacy, financial reporting, human resources, and other compliance concerns by making an anonymous and confidential call to the MedStar Integrity Hotline by calling 877-811-3411, toll free. The hotline is available 24 hours. Employees, physicians, contractors, and patients can also email the compliance officer at ocbi@medstar.net. Any person reporting fraud and abuse may also contact the MedStar Family Choice Maryland Medicaid compliance director at 410-933-2283. Retaliation for reporting in good faith, an actual or potential violation or problem, or for cooperating in a compliance legal or human resources investigation is expressly prohibited by MedStar Health policy. If overpayments related to fraudulent or abusive billing have been identified, we may retract these payments made to providers. In addition, under certain circumstances (Maryland Medicaid MCO Transmittal Number 82), MedStar Family Choice may be required to notify the Department of Health and Mental Hygiene (DHMH) OIG and Medicaid Fraud Unit (MCFU). These entities may perform their own investigation. Penalties such as fines, loss of licensure or imprisonment can occur for providers found guilty of fraudulent activity.

Federal False Claims Act: The Federal False Claims Act, 31 U.S.C. §§ 3729-3733, applies to persons or entities that knowingly and willfully submit, cause to be submitted or conspire to submit a false or fraudulent claim, or that use a false record or statement in support of a claim for payment to a federally-funded program. The phrase “knowingly and willfully” means that the person or entity had actual knowledge of the falsity of the claim, or acted with deliberate ignorance or reckless disregard of the

truth or falsity of the claim. Persons or entities that violate the Federal False Claims Act are subject to civil monetary penalties (42 U.S.C. § 1320a-7a) and payment of damages due to the federal government. Under the False Claims Act, those who knowingly submit or cause another person or entity to submit false claims for payment of government funds are liable for three times the government’s damages plus civil penalties of $5,500 to $11,000 per false claim. The Federal False Claims Act provides that any person with actual knowledge of false claims or statements submitted to the federal government may bring a False Claims Act action in the government’s name against the person or entity that submitted the false claim. This is known as the False Claims Act’s “qui tam” or whistleblower provision. Depending on the outcome of the case, a whistleblower may be entitled to a portion of the judgment or settlement. The Federal False Claims Act provides protection to whistleblowers that are retaliated against by an employer for investigating, filing or participating in a False Claims Act lawsuit.

State False Claims Acts: A number of states have enacted false claims acts in an attempt to prevent the filing of fraudulent claims to state-funded programs. The District of Columbia has established such an Act under Title 2, Chapter 3 of the District of Columbia Code. The District of Columbia law provides that any person who knowingly presents or causes to be presented a false claim, record or statement for payment by the District, or conspires to defraud the District by getting a false claim paid can be liable to the District for penalties and damages. District of Columbia law allows whistleblowers to bring claims under certain circumstances and protects whistleblowers from retaliation by employers. Virginia has a similar law, known as the Taxpayers Against Fraud Act, established under Chapter 3 of Title 8.01 of the Virginia Code. Virginia’s law also permits whistleblowers to bring actions in the name of the Commonwealth of Virginia and protects whistleblowers from discrimination by employers. Maryland has a similar law, titled the Maryland False Health Claims Act of 2010, originally enacted as Maryland Senate Bill 279. The Maryland law prohibits actions constituting false claims against state health plans or programs, permits whistleblowers to bring actions under the law and provides protection for whistleblowers from retaliation. In Maryland, the civil penalty can be up to $10,000 for each violation. There can be an additional penalty of up to three times the amount of the damages that the state sustains. Depending on the outcome, the whistleblower may be entitled to a portion of the judgment or settlement.

Requirements Pertaining to False Claims and Statements

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Compliance Audit RequestsMedStar Family Choice conducts a number of audits throughout the year. If your office is selected, you will be contacted via a written request. Our compliance audits review the following:

• Documentation: i.e. documentation supports the code(s) billed, is legible and signed by the provider who rendered the services

• Billing: i.e. overpayments, overutilization, pass-through billing

• Coding guidelines: i.e. upcoding, unbundling and correct use of codes

• Authorizations: Please be sure that what is authorized is what is billed.

Once all of the requested documentation is received and reviewed by our compliance department, we will notify you of our findings. If fraud or improper coding is identified, MedStar Family Choice has the right to recoup payments in accordance with Maryland law. If you have any questions regarding an audit, please contact Provider Relations at 800-905-1722, option 5. Please note that our audits are based on current CPT® and ICD-10® guidelines in conjunction with the current CMS and Maryland Medicaid guidelines as applicable. CMS guidelines can be reviewed at CMS.gov.

Pass-through BillingMedStar Family Choice and DHMH prohibit pass-through billing. Pass-through billing occurs when the ordering provider requests and bills for a service, but the service is not performed by the ordering provider or those under their direct employ. If you are a physician, practitioner or medical group, you must only bill for services that you or your staff perform. The performing provider should bill for these services unless otherwise approved by MedStar Family Choice.

“Per limitations provided in COMAR I 0.09.02.04, providers may only bill Medicaid for services they or their employees have actually performed when billing for a service that includes both a technical and a professional component. Providers may not bill for services they have subcontracted to be performed by a third party. For example, a Dr. Smith enters into an agreement to pay ABC Consultants directly to interpret ultrasounds that Dr. Smith has performed. The agreement does not establish an employer employee relationship. In this case, Dr. Smith would bill for the service using a modifier TC to indicate that he only performed the technical component of the service. Even though Dr. Smith has an arrangement where he has paid ABC Consultants to perform the professional component, Dr. Smith may not bill for the professional component because neither he nor his employees have performed the service. ABC Consultants would bill the Program for the professional component only using the modifier 26.”1

1. Per DHMH Transmittal Number 80, Published June 23, 2015, and COMAR 10.09.02.04.

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HIPAA Notice of Privacy PracticeAll new members receive a copy of our Notice of Privacy Practices upon joining MedStar Family Choice. The Notice of Privacy Practices outlines how MedStar Family Choice may use and disclose our member’s information, as well as when authorization for use and disclosure is required. Policies and procedures are also in place to make sure that our members’ protected health information is safeguarded and explains how MedStar Family Choice protects verbal, written and electronic protected health information, including portable electronic devices. Therefore, to ensure the privacy and security of its members’ medical information, MedStar Family Choice requires its providers to abide by a number of medical record documentation standards.

These standards include provisions such as:

• Providing a Notice of Privacy Practices to members

• Complying with all federal, state and local regulations pertaining to medical records

• Securing both paper and electronic medical records

• Ensuring the confidentiality of member information through creation of standards

• Releasing of information only to authorized staff, including those from DHMH, DOH and HHS, for quality assurance and auditing purposes

• Reporting to MedStar Family Choice in a timeframe required by law, breaches of the HIPAA privacy rules as they relate to MedStar Family Choice members and cooperation with MedStar Family Choice in the remediation of such breaches Providers must immediately report privacy breaches related to MedStar Family Choice members in accordance with the provider agreement by calling the MedStar Family Choice compliance director at 410-933-2283 or Provider Relations at 800-905-1722, option 5.

A copy of the notice is available on our website at MedStarFamilyChoice.com and hard copies can be provided upon request by calling Provider Relations.

Provider Performance DataMedStar Family Choice may utilize a provider’s performance data in numerous ways, including but not limited to:

• Recredentialing

• Pay for performance

• Quality improvement activities

• Public reporting to consumers

• Preferred status designation in the network (tiering) for narrow networks

• Reduced member cost sharing

• Other quality activities

Please contact Provider Relations at 800-905-1722, option 5, with any questions and or concerns.

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EPSDT Program Key AreasThe Healthy Kids EPSDT program focuses on five key areas:

1. Health and developmental history (assessing both mental and physical development)

2. Comprehensive physical exam

3. Laboratory tests and at risk screenings

4. Immunizations

5. Health education and anticipatory guidance

It is important to indicate:

• The head circumference measurement at each visit from ages 0 to 2 years

• A distinct or graphed BMI percentile at each visit from ages 2 to 21 years

Please note that BMI alone does not represent the progress of a growing child; percentiles are necessary.

• TB screenings starting at 6 months

• Autism screening

• Depression screening

• Continued education

• Developmental screening tools

• A dental referral starting at 12 months

It is important to remember that the Delmarva Foundation may come on site to conduct EPSDT chart audit reviews for primary care providers. By following all EPSDT guidelines with supportive documentation, your office will receive great results. Visit the Maryland Department of Health and Mental Hygiene Healthy Kids website at MMCP.DHMH.Maryland.gov/EPSDT/Pages/Home.aspx to obtain the latest copies of EPSDT encounter visit forms, Healthy Kids Preventative schedule or to access the EPDST provider manual.

MedStar Family Choice Membership CardsMedStar Family Choice does not deny claims when a member presents an ID card that does not reflect your office as the primary care provider (PCP). This is to prevent participating PCP offices from turning members away when they are active MedStar Family Choice members on the date of service (DOS). When this happens, please ask members to update their ID card information prior to their next appointment. Changing a PCP is relatively simple. Please follow these instructions if your office is not printed on the card as the member’s PCP:

• Always verify through EVS that the member is an eligible MedStar Family Choice member on the DOS by calling 866-710-1447.

• See the patient if they are active. Do not reschedule the appointment.

• Ask the member to call Member Services at 888-404-3549 to request a new member card reflecting their correct PCP name prior to the next scheduled appointment. You may allow the patient to call from your office while they are waiting to be seen.

• Follow current authorization procedures, if applicable. A list of services requiring prior authorization is available at MedStarFamilyChoice.com or can be obtained by calling Provider Relations.

Please keep in mind the importance of current PCP information in regards to member ID cards. This information is used to create member rosters that are mailed monthly to PCP offices. These rosters are used by MedStar Family Choice to send member information to provider offices as well as when making outreach attempts for members. If the roster is inaccurate, the PCP on file may consequently receive member mailings that go into the member’s chart, as well as telephone calls regarding the specific member that is not actively under their care. MedStar Family Choice rosters are also used by Vaccines For Children (VFC) nurses who supply vaccines to pediatric offices for members enrolled in the HealthChoice program. As a result, pediatric offices may not be adequately stocked with vaccines for their members. If you need further assistance regarding the member’s benefits, call our Outreach department at 800-905-1722, option 1, for the member’s ID number and effective date.

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The MedStar Family Choice claims look-up website allows providers to check the status of a claim. In order to check claims status online, providers should go to MedStarFamilyChoice.com and click on the Go to Online Claims Look-Up hyperlink under the Maryland HealthChoice section under For Physicians. This quick link will take you directly to the online claims page where you can register and/or sign on and look up a claims status. A feature for claims look up is that each office will initially register for a master account and then register all other users in their office as subaccounts. Subaccounts will allow multiple users to share the same web portal access without sharing the same username and password. The employee who is registered as the master account holder will be responsible for activating and deactivating employee logins. Prior to registering, verify that your computer is currently using either a Windows or Apple operating system that includes a supported web browser:

• Microsoft Internet

• Google Chrome Explorer 7, 8, 9, 11.0, or later

• Mozilla Firefox

• Apple Safari 3.6, 5.0.1 or later.

Once your computer is set up, registration can begin. All identifying information needed for registration must exactly match the information in our database. Therefore, we recommend that offices have an explanation of benefits (EOB) to refer to for accurate data input of the provider name, ID and address information. At this time, users will have the option to register as a:

• Facility: This option allows access to provider information associated with that medical facility, i.e., users will only be able to view the facility charge.

• Payee: This option allows access to all providers and locations associated with the payee. This is the recommended option if offices wish to view all professional claims billed from multiple office locations, as well as professional charges related to facilities that are associated with the payee’s information.

• Location: This option allows access to provider information for one physical location.

• Provider: This option allows access to only the provider’s information, i.e. the provider’s name used for the initial registration.

After registration is complete, users can set up subaccounts for other employees. To set up subaccounts:

• Click on the Setup > Subaccounts tab.

• Click Create New Subaccount.

• In the Create Subaccount window, enter the name and email address of the new user. (System-generated messages, such as password reset messages, are sent to the email address that you enter for this user. Users can change their name and email address later on the My Profile tab once they log in.)

• Enter an initial username and password for the user. (Users can change their passwords later on the Change Password tab once they log in.)

• Click Save. The new account is created and added to the Subaccounts tab where it can be edited, locked or unlocked. The subaccount user has the same web portal access as its master account including access to patient rosters, billed amount lists and attached documents. For additional help, providers can contact the Claims department at 800-261-3371 and Provider Relations at 800-905-1722, option 5, to request on-site assistance.

Online Claims Lookup and Registration

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Screening for HypertensionHypertension is a recognized global disease and affects patients of every demographic. Therefore, we encourage all practices, regardless of specialty, to check each patient’s blood pressure during an office visit with their provider, even if the patient has no prior history of high blood pressure. Many factors may increase a patient’s blood pressure and it is recommended that members with a high blood pressure reading be asked if they are under treatment for hypertension. If they are not, the patient should be encouraged to schedule an appointment with his or her primary care provider to screen for potential disease. Providers performing blood pressure checks on each patient at every office visit ensures that diseases, like hypertension, do not pass undetected and improves the chances for successful treatment. Together, the medical community can reduce the growing effects of hypertension on the patient population. For questions or concerns regarding this communication, please contact Provider Relations at msfcproviderrelations2@medstar.net or 410-933-3069.

Coordinating an Organ TransplantGetting ready for a transplant procedure takes a big commitment from the member and the member’s family. As a result, we have an organ transplant coordinator who becomes the member’s MedStar Family Choice case manager and helps them to coordinate care with the transplant team. The organ transplant coordinator begins the process by contacting the member to record detailed medical and social history and explain the program. They make sure the member knows what to expect and answers questions regarding provider appointments, what labs to expect, how long the process may take, and discusses any addiction conditions and counsels on healthy food options. The coordinator stays involved with the member and the provider office the entire time. Providers are encouraged to keep in touch with our organ transplant coordinator since prior authorization is needed for all transplant specialty appointments. The referring physician is responsible for sending all clinical documentation to MedStar Family Choice, as well as the documentation of the facility where the transplant will take place. Both members and providers can contact our Organ Transplant Coordinator, Kathy Miller, RN, at 410-933-2210 regarding this program. Authorization request including ICD-10® codes and documents supporting medical necessity should be sent via fax to 410-933-2205 or 410-933-2209.

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Referrals to SpecialistsReferrals to an in-network specialist from a primary care provider (PCP)

Providers should use the Uniform Referral Form to refer members to a specialist. Other referral forms generated by a provider’s electronic medical record (EMR) system are accepted as long as all information that is on the Maryland Uniform Referral form is represented on the referral form that the PCP is generating. If a referral is requested by a specialist on the day of a member’s visit but the referral is not ready, PCPs may give the specialist verbal consent to see that patient on the date of service so that the member does not need to be denied treatment until the referral can be completed by the PCP. If the specialist cannot obtain verbal approval from the PCP, then the specialist can see the member for one visit without the referral. The office notes should then be sent to the PCP for the member’s chart.

Referrals to an in-network specialist from a specialist

Specialists can refer to other specialists if they receive written or verbal approval from the PCP (follow the documentation steps outlined above). Providers should use the Uniform Referral form to refer members to a specialist. Other referral forms generated by a provider’s electronic medical record (EMR) system are accepted as long as all information that is on the Maryland Uniform Referral form is represented on the referral form that the specialist is generating.

If a referral is requested by a specialist on the day of a member’s visit but the referral is not ready, the referring provider may give the specialist a verbal consent to see that patient on the date of service so that the member does not need to be denied treatment until the referral can be completed by the referring provider. Document the verbal approval in the patient’s medical chart. If the specialist cannot obtain verbal approval from the PCP, then the specialist can see the member for one visit without the referral. The office notes should then be sent to the PCP for the member’s chart.

Referrals for lab and radiology services

PCPs and specialists are to directly refer their MedStar Family Choice patients for lab and radiology services to in-network facilities. Specialists should not send their members back to the PCP for a referral. All providers should use a Lab Requisition form for labs, but providers can either use

a Uniform Referral form and/or their EMR Referral form or write a script for radiology requests.

Referrals to physical therapy, occupational therapy and speech therapy

Both PCPs and specialists can refer to physical therapy, occupational therapy and speech therapy. Providers are to follow the process outlined within this article for referrals for members over the age of 21 years for up to 20 visits (the state manages patients under the age of 21 for physical therapy, occupational therapy and speech therapy). Prior authorization is required for more than 20 visits in a calendar year. Please note: Physical therapy services provided by a chiropractor are not covered and must be directed to an in-network PT provider.

All providers are encouraged to use the MedStar Family Choice “Find a Doc” feature on our website at MedStarFamilyChoice.com in order to receive assistance in finding in-network specialists, laboratories and radiology providers. Please note, all referrals to out-of-network providers requires a prior authorization. Please send all questions or queries regarding referrals to MedStar Family Choice Provider Relations to msfcproviderrelations2@medstar.net. Telephone assistance is available for Maryland providers by calling 800-905-1722, options 6, and D.C. providers can call 855-210-6203, option 5.

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Case Management for Total Joint ReplacementThe MedStar Family Choice Case Management department has a program in place to help coordinate education efforts and discharge planning for our members who are candidates for total hip and knee replacements.

Our case manager contacts the member as soon as they are pre-certified for surgery. This ensures that the member is provided with a smooth transition through the continuum of care. At this time, our case manager will verify that the member has been referred to one of the total joint replacement education programs at participating hospitals.

Then they will talk with the member about options for home care, physical therapy, equipment, and short-term skilled nursing home care if needed. After speaking with the member, they fax the proposed plan of care to the hospital’s orthopaedic case manager and contact the doctor’s office, if needed. Even though our case manager will actively work with the member, facilities and providers, we ask that the orthopedic physicians and/or office staff assist members in enrolling in pre-operative classes. Please be sure to make us aware of pending surgeries as early as possible.

Once aware of the surgery, we can begin our process with the member. It is important to keep in mind that discharge plans may change based on the clinical condition of the member and, in our experience, patients who are well prepared have better outcomes.

You can contact our MedStar Family Choice Case Management department at 800-905-1722, option 2, or fax the request with clinical information to 410-933-2274.

Updates to The MedStar Family Choice Formulary Maryland HealthChoice Updates continue to be available quarterly on MedStarFamilyChoice.com and more frequently on ePocrates. Paper booklets of the 2016 Formulary can be requested from the MedStar Family Choice Provider Relations department at 800-905-1722, option 6. Details of the prior authorization criteria are available on the MedStar Family Choice website with the other pharmacy protocols. At the March 2016 Pharmacy and Therapeutics Committee Meeting, the following changes were made to the MedStar Family Choice 2015 formulary.

Additions that have or will go into effect in the next few weeks • ANALPRAM E (2.5% hydrocortisone and 1 percent

pramoxine)

Additions with prior authorization* effective on or around April 1, 2016

• ALECENSA is a kinase inhibitor indicated for the treatment of patients with anaplastic lymphoma kinase (ALK)-positive, metastatic nonsmall cell lung cancer (NSCLC) who have progressed on or are intolerant to crizotinib.

• AMPYRA (dalfampridine extended release [ER]) tablets, formerly referred to as fampridine sustained release, is the first and only therapy approved by the Food and Drug Administration (FDA) that is indicated to improve walking in patients with multiple sclerosis (MS) (Acorda Therapeutics, 2010).

* Please see the PA Table for details of the requirements for approval and

guidance on submission of clinical information.

Removals effective on or around April 1, 2016• None

Removal of prior authorization• None

Managed drug limitations and step therapy• None

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The National Correct Coding Initiative (NCCI) is a program developed by the Centers for Medicare and Medicaid Services (CMS) that consists of coding policies and edits. NCCI edits address correct coding combinations submitted by a provider for multiple services in regards to the same patient, on the same anatomic site and on the same date of service.

There are two types of edits: procedure-to-procedure edits and medically unlikely edits (MUEs). Procedure- to-procedure edits make certain that CPT and/ or HCPCS codes billed together are eligible for separate reimbursement and medically unlikely edits (MUEs) ensure that the appropriate number of units for a particular service were billed.

MedStar Family Choice claims processing center utilizes nationally recognized vendor CCI edit software so that providers are reimbursed for services in accordance with the NCCI procedure-to-procedure edits. We also expanded our existing NCCI edits to include the MUEs for professional claims and some types of outpatient facility claims. This logic includes a maximum number of units of service for each HCPCS/CPT code. Claims that do not meet criteria set in the CCI edit software are denied. Instances when a claim is denied because of NCCI procedure-to-procedure edits include, but are not limited to:

• Mutually exclusive codes that cannot be reported together were billed.

• Unbundling of codes when a single comprehensive CPT code is available. Since 2010, MedStar Family Choice has been using the NCCI methodologies in place for Medicare Part B because these methodologies are compatible with methodologies for Medicaid claims. MedStar Family Choice has removed the requirement for a 25 modifier on injections with E and M visit codes and for pulse oximetry monitoring with E and M visit codes.

Since July 5, 2015, MedStar Family Choice has incorporated CMS/Medicaid MUEs into our policies. Therefore, additional MUEs that are compatible with Medicaid will be applied even though they are not applied by Medicare. Please keep in mind that many procedure codes have CCI edits associated with them. Providers should use applicable modifiers when services are in fact separate and independent from each other in order for claims to be processed and paid as separate procedures. Since modifiers can be used to bypass CCI edits, MedStar Family Choice monitors their use. Therefore, if a modifier

is to be used to bypass CCI edits, it is imperative that providers clearly document and explain the circumstances of the services that were provided in the member’s chart. The documentation must clearly show that the procedure code and modifier met the conditions for separate billing.

At this time, coding edits affect professional and outpatient claims submitted on CMS-1500 forms, as well as outpatient facility claims submitted on UB-04 (CMS-r1450) forms. For Maryland Health Choice providers, it was determined by the Department of Health and Mental Hygiene (DHMH), in conjunction with CMS, that procedure-to-procedure edits for outpatient hospital claims regulated by the Health Services Cost Review Commission are not permissible. The DHMH clarified that the only outpatient coding edits that must be implemented for regulated outpatient hospital claims are a subset of edits identified under the CMS Integrated Outpatient Coding Edits (I/OCE). Visit CMS. gov/OutpatientCodeEdit/Downloads/Attachment_A_ IOCE_Specifications_Document_V113.pdf for a detailed listing of permissible edits. Pages 12 to 13 of that document include a listing of OCEs. Those marked with a “Y” in the “Non-OPPS Hosp” column are permissible and are used as edits in the MedStar Family Choice claims system.

If you need more information regarding NCCI methodologies and the appropriate usage of modifiers, you can go to the Centers for Medicare and Medicaid Services website at CMS.gov for the National Correct Coding Initiative Policy Manual, as well as the Medicaid National Correct Coding Initiative Edit Design Manual at: Medicaid.gov/Medicaid-Chip-Program-Information/ByTopics/Data-and-Systems/Downloads/2014-MedicaidNCCI-Edit-Design-Manual-Rev-3/14.pdf

National Correct Coding Initiative and Outpatient Coding Edits

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Did you know?When addressing tobacco dependence …

• Combining long-acting nicotine replacement treatment (NRT) options—like the patch—with short-acting NRT—such as the gum, lozenge or spray—can support quitting.

• Combination pharmacotherapy—using Varenicline and Bupropion SR together—appears to be more effective than use of either alone (Ebbert et al., 2009).

Visit MDQuit.org/Cessation-Programs.

Verifying Member Eligibility for Medicaid Products Prior to rendering services, provider offices must verify that MedStar Family Choice Medicaid members have benefits on the date of service. If a member does not have benefits on the date of service, then claims will deny. Along with verifying member benefits, providers should be familiar with MedStar Family Choice products and that their office is contracted as a participating provider. Since MedStar Family Choice participates in the Maryland HealthChoice program, the District of Columbia Healthy Families and the D.C. HealthCare Alliance program, providers should note which cards members are presenting and that they are contracted as a par provider because each Medicaid product is contracted separately. Sample member ID cards for each Medicaid product is available on our website at MedStarFamilyChoice.com. Please follow these steps to determine eligibility for your MedStar Family Choice/Maryland HealthChoice patients:

• Call the Maryland EVS line at 866-710-1447 to verify if a patient is eligible to receive benefits and is active with MedStar Family Choice on the date of service. More information on the EVS line can be found at EMDHealthChoice.org

• If providers have further questions regarding member benefits under MedStar Family Choice, please contact the MedStar Family Choice Outreach Department at 800-905-1722, option 2. Requests for printed materials can be directed to MedStar Family Choice Provider Relations at msfcproviderrelations2@medstar.net or by calling 800-905-1722, option 6.

Contact UsEach participating MedStar Family Choice provider is assigned a provider representative to assist offices with questions regarding the MedStar Family Choice health plan. Your representative is assigned to you according to the ZIP code of your office. If you are not certain who your provider representative is, please call or email MedStar Family Choice Provider Relations, and we can assist you.

Provider relations main telephone number: 800-905-1722, option 5 855-600-3077 FAX msfcproviderrelations2@medstar.net EMAIL

You may contact MedStar Family Choice, Monday through Friday, between 8:30 a.m. and 5 p.m. Providers have the option to leave a message or send a fax after normal business hours. However, any calls and faxes received after hours will be addressed the next business day.

Please call 800-905-1722:

Option 2 for Pharmacy, pre-authorizations, inpatient reviews and case management

Option 1 for Outreach, transportation and eligibility verifications

Option 3 for Member Services or denials and appeals

Option 4 for Claims. Please listen for further options.

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5223 King Ave., Suite 400 Baltimore, MD 21237 888-404-3549 PHONE

The MedStar Family Choice Newsletter is a publication of MedStar Family Choice.

Submit new items for the next issue to Arion Long, MedStar Family Choice, arion.k.long@medstar.net

Kenneth A. Samet, FACHE President and CEO, MedStar Health

David Finkel President, MedStar Family Choice

Arion Long Managing Editor, Health Plan Communication Specialist

MedStarFamilyChoice.com

Claims Address ReminderThe claims address for MedStar Family Choice Maryland HealthChoice members changed on Sept. 1, 2015. The telephone number remained the same. All claims and overpayment refunds should only be mailed to the new address at:

MSFC Maryland Claims PO Box 2189 Milwaukee, WI 53201 800-261-3371

Please contact Provider Relations at 800-905-1722, option 5 or email Provider Relations at msfcproviderrelations@medstar.net with questions and/or to request written materials.

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