Update in Procedure for Submitting Claims Reviews

Immediately: Billing and appeals teams must update their MCO/ASO dispute resolution submission procedures to comply with this policy. REQUIREMENTS: (1) When submitting claims disputes to Maryland's MCO/ASO Dispute Resolution Committee, ensure ALL seven required document categories are included: MCO and ASO remittance reports, appeal responses from both entities, UB04 form, claim denials, and medical records (physician notes and admission/discharge reports ONLY—explicitly exclude lab reports, nursing notes, and x-rays). (2) Verify that the MCO/ASO Dispute Resolution Review Form is completely filled out in all four required sections: Hospital Information, Patient Claim Information, ASO Remittance Information, and MCO Remittance Information. (3) Use ONLY secure transmission methods (faxed, mailed, or password-protected secure email) due to PHI content. (4) Direct all complete submissions to: Behavioral Health Administration, ATTN: MCO/ASO Dispute Resolution Committee, Spring Grove Hospital Center - Dix Building, 55 Wade Avenue, Catonsville, MD 21228. (5) Train staff that incomplete submissions will be returned or delayed—do not contact the Committee within the 45-day review window. (6) Confirm disputes are within scope: only medical vs. psychiatric treatment classification disputes are accepted; exclude payment receipt issues, cases exceeding one year old, commercial payors, active appeals, and medical necessity/procedural requirement disputes.