• Procedure for Resolving Disputes Over Negative Balances
• Incedo and CARC Denial Code Description Crosswalk
• PRP Administrative Denial List (Sample, Effective 3.7.22)
• Residential Eating Disorder Program 
• 277CA Edits Spreadsheet  (Updated 6/22/22)
• Window of Authorization Submission
• OMHC Affidavit
• Supported Employment Checklist
• Billing Appendix (pdf)
• Optum Provider Survey
• Token Registration (pdf)
• Incedo Provider Portal Functionality
• Behavioral Health Toolkit for Providers - Military and Veterans

Emergency Petition Documents

• Application for Involuntary Admission (pdf)
• Certificate to Accompany Involuntary Admission (pdf)
• Certification by Peace Officer (pdf)
• Request for Emergency Room Fee (letter template)
• Request for Psychiatric Evaluation (letter template)
• Request for Transportation (letter template)

• PRP Frequently Asked Questions (Updated October 2021)
• Outpatient Authorizations FAQ (10.4.21)
• Understanding the 277 Claims Acknowledgement (277CA) Transaction FAQs
• Assisted Reconciliation Frequently Asked Questions 
• Dual Check-Write Frequently Asked Questions
• Psychiatric Rehabilitation Programs (PRP) FAQs
• ASO Transition FAQs
  
• Estimated Payments FAQs - Updated 02-05-20
• Provider FAQs
• Opioid Treatment Providers FAQs

Quick Reference Guides (QRGs):

• Quick Reference Guide to Recoupment and Offset Codes used on the PRA
• Provider Remittance Advice (PRA) QRG
• Claim Lifecycle Report Quick Reference Guide
• Eligibility Verficiation System (EVS) User Guide
• Downloading Incedo Provider Portal Reports Quick Reference Guide
• Negative Balance PRAs Quick Reference Guide
• Instructions for Exporting Authorizations in Incedo
• Descriptions of Incedo Provider Portal Claim Statues QRG
• Claims Rejection Report QRG
• Assisted Reconciliation Report 5 QRG
• Understanding the Retro-Eligibility Process
• Understanding the 999 Functional Acknowledgement QRG
• Claim Denials and Rejections QRG
• Connecting to Webex Audio QRG
• Incedo Provider Portal Claims Management Quick Reference Guide (pdf)
• Incedo Provider Portal Submit Attachments Quick Reference Guide (pdf)
  
• Claims Management Quick Reference Guide (pdf)
• Incedo Provider Portal Quick Reference Guide

Provider Guides:

• Claims Submission Companion Guide: Professional Transactions (pdf)
• Claims Submission Companion Guide: Institutional Transactions (pdf)

ePREP for Provider Medicaid Enrollment and Registration with Optum

The state of Maryland has implemented the electronic Provider Revalidation and Enrollment Portal (ePREP). This resource enables online provider enrollment, re-enrollment, revalidation, information updates, and demographic changes. For resources to assist you with ePREP, visit the Maryland Department of Health Provider Enrollment information page.

To create a user profile or log into an existing account for Maryland Medicaid’s ePREP portal, visit ePREP.health.maryland.gov. After enrollment at Maryland Medicaid, register with Optum using Incedo Provider Portal.

Clinical/Utilization Management

The Maryland Public Behavioral Health System (PBHS) is committed to facilitating the participant’s recovery through treatment and rehabilitation services that are in the least restrictive and intensive level of care necessary to provide safe and effective treatment and meet the participant’s biopsychosocial needs. The continuum of care is a fluid treatment pathway, where participants may enter treatment at any level and receive services, in more or less intensive settings or levels of care, as their changing clinical needs dictate. Optum will implement this philosophy while facilitating participant choice in the treatment process.

For more information regarding covered diagnoses and priority population, please see the below. The diagnosis are also listed in COMAR 10.09.70

• ICD-10 Mental Health Diagnosis (Effective 10-01-15) (Revised 10-27-22) (pdf)
• ICD-10 Substance Use Disorder Diagnosis (Effective 10-01-15) (Revised 10-1-22) (pdf)
• ICD-10 Poison Diagnosis (Eff. 4-1-16) (Revised 10-1-22) (pdf)
• ICD-10 Gambling Diagnosis (Effective 01-01-18) (pdf)
• Priority Population Diagnosis – January 12, 2021 (pdf)
  

Optum authorizes services for the Public Behavioral Health System. Below are a few examples of specialized services that are available for Maryland individuals that meet the Medical Necessity Criteria (MNC). If you would like more information regarding all covered services, please review our Provider Manual for full description and MNC.

Intensive Case Management Program

It is the policy of Optum to offer members with complex and high risk behavioral /medical conditions the enhanced services of an Intensive Case Management (ICM) program. This program is available to all Optum members as a value-added service, contingent on available program resources. It does not replace or conflict with the Medicaid approved service of Targeted Case Management. Criteria that must be met to be eligible for intensive case management include, but are not limited to, multiple hospitalizations within the past year and/or a co-morbid medical diagnosis.

To refer a member to ICM, please call 800-888-1965 for more information.

Care Coordination

The Maryland Public Behavioral Health System (PBHS) emphasizes communication between mental health providers, medical care providers, and substance related disorder providers. Optum has embraced this integrated philosophy and provides key services that will enable better coordination of care for an individual’s treatment teams. With the consent of the individual through a completion of a release of information (ROI) form, the treating behavioral health provider(s) communicate directly with the medical care provider on a regular basis in order to coordinate behavioral health and somatic health care. Interdisciplinary and interdepartmental conference calls, data sharing, treatment planning, and outreach to participants are all options for coordinating care on high-risk participants. To assist in this coordination of care, Optum also communicates with the HealthChoice Managed Care Organizations (MCOs), the Maryland Department of Health and local stakeholders regarding high-risk participants with co-occurring behavioral health conditions and medical disorders.

To learn more about Care Coordination, please review the Provider Manual or the PCP Toolkit on our Non-Behavioral Health provider page.

1915(i)

The 1915(i) services are intensive behavioral health services for children, youth, and families and builds upon the prior 1915(c) RTC waiver that allowed states to provide home and community-based care to participant’s that would otherwise be institutionalized. Included in the 1915(i) program are an array of diagnostic and therapeutic mental health services, including 24-hour availability of mental health and/or crisis services, which are provided to the child or adolescent and family using a wraparound approach that includes intensive care coordination with an individualized plan of care. Specialized services not otherwise available through the Medicaid program include mobile crisis stabilization, respite services, intensive in home services, expressive and experiential behavioral services, and family and peer support services.

• TCM/1915(i) Referral Form

Compliance

• COMAR Regulations