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Claims

Claims Status/Online Claims Look Up

To obtain information on the status of your claims, please log on to the online claims look up website or call our Claims Department at 800-261-3371. Our Claims Department is available Monday through Friday 8:30 a.m. – 5 p.m. 

A new feature for the online 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 user name and password. The employee who is registered as the master account will be responsible for activating and deactivating employee logins. If your office doesn't already have an account, you may also register to obtain online claims status.

Requirements False Claims Act

Find out 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.

Fraud and Abuse Retractions

If overpayments related to fraudulent or abusive billing has been identified, MedStar Family Choice may retract payments made to providers. In addition, under certain circumstances (Maryland Medicaid MCO Transmittal No. 82) MedStar Family Choice may be required to notify the Maryland Department of Health OIG and Medicaid Fraud Control Unit (MCFU) of the retraction.

Emergency Room Auto-Pay List

Find out which emergency room diagnosis codes are on the auto-pay list.

Claims and Billing Procedures

Find out the guidelines for timely claims submissions.

Claims Submissions

Find out which fields are required to be completed in order for the claim to be considered clean.

Electronic Claims Submission

Are you submitting claims electronically? Learn how to send your MedStar Family Choice claims electronically.

Denial Codes and Reasons

Obtain a full list of current denial codes and associated descriptions.

Claims Appeals

Find out the timeframe and address for sending appeals to MedStar Family Choice.

Claims and Refunds

Learn where to send refunds for errors in claims payments.

National Drug Code (NDC)

As a result of the Affordable Health Care Act, there is a new requirement that impacts how you bill your claims.

Modifier 32

Effective October 1, 2010, providers must bill some preventative medicine evaluation and management CPT codes with a 32 modifier (mandated service) when billing initial medical examinations.

Modifer TH

Effective June 27, 2011, providers must bill a delivery code that includes the postpartum visit when the physician intends to provide postpartum care.

Observation Authorization

Prior authorization is required for elective and direct placement into observation (i.e. from home, physician office, etc.)

Visual Evoked Response (VER) / Visual Evoked Potential (VEP)

Effective, November 10, 2011, the VER/VEP tests will not be reimbursed separately when provided by a primary care provider for a MedStar Family Choice Member.

Information current as of: 07/25/17