Claims Submission

MedStar Family Choice follows the Maryland Clean Claims Legislation adopted under COMAR 31.10.11 in order to determine whether a claim is clean.

Standard Required Attachments

The following describes circumstances under which the identified attachment is required for submission with the claim.

  • An explanation of benefits statement from a primary payer to MedStar Family Choice's Claims Processing Center, if MedStar Family Choice is secondary.
  • A Medicare remittance notice, if Medicare is primary and MedStar Family Choice is secondary.
  • A description of the procedure or service, which may include the medical record, if a procedure or service has no corresponding Current Procedural Terminology (CPT) or HCPCS code.
  • Information related to an audit, if a pattern of fraud, improper billing, or coding is demonstrated.
  • Admitting and physician notes for emergency services that may not meet the standards for an emergency service. See the ER auto-pay list for a full list of codes.
  • An itemization of charges is required, to include CPT/HCPCS codes, for outpatient hospital claims billed on a UB04 with the Revenue Code 250 series, on those claims that are greater that $500 billed charges.  An itemization is not required if the CPT/HCPCS codes are initially billed on the claim.
  • A itemization of charges may be required for inpatient hospital claims to correctly pay a bed day when other similar bed days are denied in that same inpatient admission.

Please share this information with your staff and/or billing agent as appropriate.

Information current as of: 12/14/17