7/14/21 - Nursing Facilities
5/27/21 - Please review the attached memo and guidelines regarding nursing facility PWC request.
4/15/21 - DME and DMS providers, MDH has removed the Invoice Control Number from the PEN Authorization form. Attached is the most up to date PEN form for immediate provider use. Also, MDH has released a list of frequently asked questions for PEN to assist providers in the Enteral submission process.
DME and DMS providers: Please review the attached memo regarding updated clarification and PEN form for use with Parenteral and Enteral Nutritional Supplements.
DME and DMS providers please view the attached memos regarding updates to the transition of Parenteral and Enteral Nutrition Supplements from the Pharmacy Program to the Disposable Medical Supplies/ Durable Medical Equipment Program, as well as a PEN authorization form including billing instructions.
Portal Registration just got easier
Telligen is pleased to announce a simplified process for registration to our Qualitrac portal. Effective immediately, all new portal registrations will be completed entirely online. Simply click on the First Time Portal Registration - Sign Up button to get started.
Signatures will be completed electronically using DocuSign technology with a final version of the document routed to you for your files. When you receive your final version, our registration team will automatically receive your packet via DocuSign and will process your registration within 5-7 business days.
NOTE: You no longer need to have your form notarized or mail your packet to us.
DME providers, please view the memo from the Division of Community Support Services: DME/SMS Oxygen Unit regarding the medication Relizorb, HCPCS code B4105.
The Maryland Department of Health (MDH) is providing additional clarification regarding nursing facility residents who become eligible for Medicaid following a period of Medicare coverage as a result of COVID-19 activity as declared by the Centers for Medicare and Medicaid Services (CMS). Please view the memo for full details.
Issued: August 17, 2020 - Revision to Secretary Neall’s Public Notice regarding Provider Medicaid Timeframe to Request a Participant Fair Hearing and File Provider Appeals Extensions
Effective August 1, 2020, the Maryland Department of Health’s (MDH) Utilization Control Agent, Telligen, will be releasing an update to their web-based provider portal, Qualitrac. Current Qualitrac users will be required to reset their passwords when they first login to Qualitrac 3.0 on or after this date. Usernames will remain the same. See full memo for training opportunities.
Effective Monday January 21, 2019, all Nursing Facilities will be required to provide signed admission orders when submitting a 257. Please see the attached memo from the Maryland Department of Health.
Effective February 1, 2019, nursing facilities and hospitals seeking medical eligibility for Medicaid nursing facility benefits must use Telligen's qualitrac portal. Training and user setup is available. Please see complete memo by clicking here for all details.
Effective immediately, providers should complete a correction request form if a change is needed to information that was submitted on the preauthorization request, such as provider name and number or dates of service. If a change is needed, please complete the attached Audiology Provider Corrections Form and fax it to Telligen at 1-888-297-4276. This form can also be found at the following websites: http://www.telligenmd.qualitrac.com/document-library and https://mmcp.health.maryland.gov/Pages/Provider-Information.aspx. Please do not submit a new review request through Qualitrac in order to make a correction to a previously submitted preauthorization request. This will create a duplicate preauthorization number which may cause delays in payment. If you have any questions, please contact Stephanie Hood at 410-767-3998 or email firstname.lastname@example.org.
Effective October 1, 2018, Telligen, Inc., Maryland Department of Health's utilization control agent, will complete review for Maryland Medicaid participants who request disposable medical supplies (DMS) requiring preauthorization. Please read the complete memo for full details. For any facility affected by this change, Telligen will be providing training on October 3. Training details can be found here.
On May 8, 2018, Maryland Department of Health released a memorandum. This memorandum serves as a reminder to DME providers of several best practices regarding the Qualitrac Portal. The recommendations contained in the document serve to help minimize errors and assure timely review processing.
Maryland Department of Health released a transmittal on March 9, 2018, explaining the revised process for submitting retroactive eligibility cases to Telligen for review. These cases can now be submitted through the Telligen Provider Portal. Please find complete details by reading the transmittal here.
The Telligen Provider Portal will enforce password changes every sixty days starting August 1, 2017. Please review the instructions on how to change a password in the system. The attachment also provides information for the Telligen Help Desk if you need assistance or have any questions.
Maryland Department of Health has released a new memo providing guidance on Section 2302 of the Affordable Care Act. Medicaid participants under age 21 for whom hospice care is elected are entitled to services that are curative or life-prolonging as well as to palliative treatment. This transmittal specifically discusses how providers may seek reimbursement for medical supplies, adaptive and other medical equipment, and oxygen/respiratory equipment that are not directly connected to palliation of the terminal condition.
Maryland Department of Health released a memo on May 24, 2017 adding additional Durable Medical Equipment procedure codes to be submitted for review to Telligen. Please see the attached memo for details and a complete listing of the additional codes.
Please review the latest instructions for processing Retro-Eligibility cases for Acute reviews. Maryland Department of Health is requesting that providers attach a copy of the Retro-Eligibility Decision Form to all UB04's submitted for retro-eligibility cases in order to avoid having the claim deny for timely filing. When submitting a claim for dates of service more than a year old, the UB04 must be submitted to the Department on paper.
Maryland Department of Health provided a memo to ensure everyone is aware of the new process for submitting retroactive eligibility cases for review, effective immediately. The Retro-Eligibility Review Request Form is available on our website under the Document Library page or by following the link in the transmittal.
Maryland Department of Health provided a memo to update the procedure codes to be submitted to Telligen. The list now includes procedure codes E1161, E1232-1238 (wheelchairs), and T5001 (positioning chair used for feeding). See the memo below, dated March 2, 2017, for complete details.
Telligen, The Maryland Department of Health's utilization control agent, is offering training sessions for DME providers. In addition to providing pertinent program information and updates, these session will cover recent system upgrades to Qualitrac, which will enhance processing of DME reviews. Please see the attached memorandum or go to the Education and Training page of this website for more information and to learn how to register.
When submitting requests for an E-fix, Telligen will only review the case IF it is in addition to a manual wheelchair request that is under review. All other E-Fix requests should still be submitted to DHMH.
NEW CODE - E1012 for the Center Mount Power Elevating Leg Rest went into effect 10/1/16. NOTE: THIS REPLACES CODE K0108.
Additional information: Qualitrac is automatically generating a request for Additional Information Letter which gives providers 1 day to return the information.
PLEASE DISREGARD THIS INSTRUCTION. Telligen allows the provider 20 days to submit Additional Information before the review is completed.
Providers please note that when a request is being reviewed for medical necessity and the item can be Rented or Purchased; Telligen may change the request from a Purchase to a Rental based on medical necessity.
Ultralight Wheelchairs - K0005
Telligen will now be processing requests for the Ultralight Wheelchairs - please submit these through the provider portal
Attention: For all facilities that are entering 3808 reviews (Prior Authorization, Concurrent, and/or Retrospective) through the Provider Portal, when you reach the Provider and Facility Search page, please use MA Number to search in the Treating Facility field. This will enable you to find the facility much quicker and confirm that you have found the correct facility.