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.
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.
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.
Find out which emergency room diagnosis codes are on the auto-pay list.
Find out the guidelines for timely claims submissions.
Find out which fields are required to be completed in order for the claim to be considered clean.
Are you submitting claims electronically? Learn how to send your MedStar Family Choice claims electronically.
Obtain a full list of current denial codes and associated descriptions.
Find out the timeframe and address for sending appeals to MedStar Family Choice.
Learn where to send refunds for errors in claims payments.
As a result of the Affordable Health Care Act, there is a new requirement that impacts how you bill your claims.
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.
Effective June 27, 2011, providers must bill a delivery code that includes the postpartum visit when the physician intends to provide postpartum care.
Prior authorization is required for elective and direct placement into observation (i.e. from home, physician office, etc.)
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.