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Toll Free: 866-571-3629

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Welcome to Delmarva’s Maryland Medicaid Website!

This site is your one-stop shop for information about our work as the Utilization Control Agent for the Maryland Department of Health and Mental Hygiene (DHMH) External Website Icon.

Click here for additional information and details...

Provider Updates, Alerts & Announcements

New Utilization Control Agent(UCA) for Maryland Medicaid - January 29, 2016

Effective Friday, January 29, 2016 Delmarva Foundation is no longer the UCA for Maryland Medicaid. The Department of Mental Health and Hygiene (DHMH) is working with the new UCA, Telligen, on a transition plan.

Delmarva Foundation is no longer accepting requests or materials for any type of review related to the Maryland Medicaid contract. Any review requests or medical records recieved by Delmarva beginning January 30, 2016 via mail, FedEx, or UPS will not be accepted and will be returned to the sender. If you have any questions during the transition, please contact DHMH at dhmh.maltcf@maryland.gov.

Incomplete Medical Records for 3808 Retrospective Reviews - Dec 2, 2015

Delmarva has recently experienced an increase in the number of 3808 Retrospective Review requests submitted with incomplete medical records. Note that submitting incomplete medical records will delay the process of your 3808 Retrospective review. Some examples of missing information includes: Physician/Nursing progress notes, Medication Administration Records, Therapy logs, and Lab results.

Please be sure to send a complete medical record with all 3808 Retrospective review requests.

A complete Medical Record consists of the following information:

  • Allergy records – NKA is acceptable
  • Anesthesia records
  • Care plans
  • Consultation reports
  • Discharge summaries
  • Emergency department records
  • Functional status assessments
  • Graphic records (vital signs, weight, etc.) when available
  • History and physical examination records
  • Intake and output records
  • Medication administration records
  • All orders, including inpatient, observation, discharge, medications, treatments, tests, imaging, etc. as well as all standing, telephone, and verbal orders
  • Medication profiles
  • Nursing assessments
  • Operative and procedure reports
  • Pathology reports
  • Practice guidelines or protocols and clinical pathways that imbed patient data
  • Problem lists
  • Progress notes and documentation (multidisciplinary, excluding psychotherapy notes)
  • Psychology and psychiatric assessments and summaries (excluding psychotherapy notes)
  • Records received from another healthcare provider if they were relied on to provide healthcare to the patient
  • Respiratory therapy, physical therapy, speech therapy, and occupational therapy records
  • Reports of results of tests and studies from laboratory and radiology
  • Wave forms such as ECGs and EMGs from which interpretations are derived

Please contact Provider Services with questions.
Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

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   Updates, Alerts, and Announcements Archive

iEXCHANGE® Administrators - Action Required - Nov 17, 2015

On 11/2/15 a notice was sent to inform all facilities that the iEXCHANGE® Administrator's had to review the user accounts in their Provider Group and maintain their user lists. At this time some facilities have not completed the maintenance.

This is a reminder that the account review and maintenance is REQUIRED to be completed by the facilities iEXCHANGE® Administrator's and that not properly maintaining system access is a HIPAA violation that is reportable to the Department of Justice Office of Civil Rights.

For those that have completed this task, thank you for your cooperation.

If you have not done so already, please review and maintain your organizations user accounts as follows:

  1. All users accounts for those who are no longer employed by your organization or who no longer need access to iEXCHANGE® must be inactivated.

  2. There should be a maximum of 3 accounts that have Administrator access for each provider. Any organization with more than 3 will need to modify the user account privileges to "Staff" for all other users that still need access.

Note: The number of iEXCHANGE® Administrators are limited to three for each organization to ensure there are backups in the event the main iEXCHANGE® Administrator is not available.

Please contact Provider Services with questions.

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

iEXCHANGE® Upgrade Alert - Nov 13, 2015

On Sunday, November 15th, MEDecision will implement an upgrade to iEXCHANGE® Fall 2015 Release. The upgrade is scheduled to take place during the monthly maintenance timeframe from 12:00 pm to 4:00 pm ET at which time iEXCHANGE® will not be available.

Please note that the upgrade will not have an impact on how you enter requests for Delmarva Foundation. However, the one change that will be realized is the supported versions of the Internet Explorer that can be used to access iEXCHANGE®. After the upgrade, the following browsers versions will be supported for iEXCHANGE®:

Internet Explorer 6, 7, 8, 9, 10, and 11
Mozilla Firefox (all versions)

Please contact Provider Services with questions or issues after the implementation.

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

iEXCHANGE® Administrators - Action Required - Nov 2, 2015

It is the iEXCHANGE® Administrator's responsibility to manage iEXCHANGE® user accounts for your provider organization. A recent review of Provider Group accounts by Delmarva and DHMH has determined that many groups have not been properly maintained. Managing iEXCHANGE® user accounts includes creating new accounts,  assigning proper access roles, and inactivating accounts when a user is no longer employed by your organization or when they no longer need access to iEXCHANGE. Not properly maintaining system access is a HIPAA violation that is reportable to the Department of Justice Office of Civil Rights.

Additionally, your iEXCHANGE® ID (Provider Group ID) is specific to your organization and should under no circumstances be provided to any person not directly employed by the facility or to anyone that does not have an active iEXCHANGE® account.

To comply with the requirements, iEXCHANGE® Administrators must review and maintain their user account lists and complete the maintenance by close of business on Monday, November 9th, 2015. After this date we will be auditing accounts for compliance.

Please review and maintain your organizations user accounts as follows:

  1. All users accounts for those who are no longer employed by your organization or who no longer need access to iEXCHANGE® must be inactivated.

    Note: iEXCHANGE® Administrators are responsible to create new accounts as well as to inactivate accounts when people are no longer employed by your organization. Continuing user access after the user leaves the organization’s employ is a reportable HIPAA violation. All users accounts for those who are no longer employed or who no longer need access to iEXCHANGE® must be inactivated.

  2. There should be a maximum of 3 accounts that have Administrator access for each provider. Any organization with more than 3 will need to modify the user account privileges to "Staff" for all other users that still need access.

    Note: The number of iEXCHANGE® Administrators are limited to three for each organization. This is to ensure there are backups in the event the main iEXCHANGE® Administrator is not available. All other users shall be provided Staff permissions only.

Please contact Provider Services with questions:

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

ICD-10 Compliance Begins Tomorrow, October 1, 2015

Reminder: Tomorrow, Thursday, October 1st, is the compliance date for ICD-10 coding.

Starting tomorrow all new requests for MDMA should be submitted using ICD-10 codes with the exception of 3808 Retrospective reviews.

Going forward, 3808 Retrospective Reviews must follow the guideline below in order to have the claim paid. Note that claims will not be paid when the inappropriate coding scheme is used.

    • Use ICD-9 codes when discharge date is PRIOR to 10/01/2015
    • Use ICD-10 codes when discharge date is 10/01/2015 or AFTER

For more information on iExchange see the documentation in: What’s New in iEXCHANGE® for ICD-10 [pdf]

For ICD-10 code reference, a list of the 2016 ICD-10-CM valid codes is posted on the CMS website at http://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-CM-and-GEMs.html.

Please contact Provider Services with questions or issues:

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

ICD-10 Coding for 3808 Retrospective Reviews ~ Sept 28, 2015

As we approach the compliance date for ICD-10 coding this Thursday, 10/1/15, we want to ensure a smooth transition and share testing results from a recent test conducted with a group of 24 randomly selected hospitals. In this test, hospitals submitted 3808 Retrospective Review requests via iEXCHANGE® using ICD-10 codes.

The following should be noted which will impact getting paid for claims:

During the testing a few hospitals entered cases with ICD-10 codes where the discharge date was prior to the compliance date.  In this case iEXCHANGE® provided a warning message indicating that ICD-9 codes should be used.  The system allowed the user to bypass this warning and submit the request, however, once the claim number is generated and sent to DHMH, the claim will not process when the inappropriate coding scheme is used. Since the request will not pass the validation at the state, it will not allow the claim to be paid. When this happens, providers will need to resubmit with the proper codes.

Pay close attention to the warning messages in iEXCHANGE® and ensure you have entered the proper code type (ICD-9 or ICD-10) for all codes in the request. Remember that a code warning could indicate an incorrect entry for the Admit Date (year or date) or for the length of stay which is used to determine the discharge date.

Ensure that when entering codes you have followed the instructions below to not impact having claims paid.

3808 Retrospective Reviews
These requests are to be based on Discharge Date (determined by the Admit Date and Requested length of stay) and should use codes as follows:

    • Use ICD-9 codes when discharge date is PRIOR to 10/01/2015
    • Use ICD-10 codes when discharge date is 10/01/2015 or AFTER

Please contact Provider Services with questions or issues.

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

ICD-10 Coding for Acute Hospitals ~ Sept 25, 2015

The iEXCHANGE® system for Delmarva Foundation is now accepting both ICD-9 and ICD-10 Diagnosis and Procedure codes, however, the coding scheme you use for requests should follow the instructions below:

Preauthorization Reviews
These requests are to be based on the Admit Date and should use ICD-9 codes until 10/1/15. Begin to use ICD-10 codes on 10/1/15.

Note: If an admission authorized in September is postponed to October, contact Delmarva with the revised date and ICD-10 codes to be used on the request.

Concurrent Reviews
These requests and extensions are to be based on Discharge Date (determined by the Admit Date and Requested length of stay) and should use codes as follows:

  • Use ICD-9 codes when discharge date is PRIOR to 10/01/2015
  • Use ICD-10 codes when discharge date is 10/01/2015 or AFTER

Note: From now until 10/1/15, since the Actual Discharge Date is not known when entering the request ICD-9 Codes should be used. If the stay continues past 10/1/15, then any extensions added after this date should use the ICD-10 codes.

3808 Retrospective Reviews
These requests are to be based on Discharge Date (determined by the Admit Date and Requested length of stay) and should use codes as follows:

  • Use ICD-9 codes when discharge date is PRIOR to 10/01/2015
  • Use ICD-10 codes when discharge date is 10/01/2015 or AFTER

Documentation on the changes can be found on our Provider Website which provides step-by-step instructions on entering and searching for Diagnosis and Procedure codes. This information can be found in the following document: What’s New in iEXCHANGE® for ICD-10 [pdf]

Please contact Provider Services with questions or issues.

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

iEXCHANGE® System Changes for ICD-10 Alert ~ Sept 21, 2015

On Monday, September 21st, the iEXCHANGE® system will begin to accept ICD-10 Diagnosis and Procedure codes in order to be compliant with the 10/1/15 deadline as required by CMS.

Beginning on 9/21/2015:

  • ICD-10 Codes will be available for entry and searching in iExchange
  • The code type is determined based on the date of discharge as follows:
    • Use ICD-9 codes when discharge date is PRIOR to 10/01/2015
    • Use ICD-10 codes when discharge date is 10/01/2015 or AFTER

Changes have been made to the MEDecision iEXCHANGE® system to allow for entering ICD-10 codes. Delmarva Foundation has provided documentation on our Provider Website to describe the changes and provide step-by-step instructions on entering and searching for Diagnosis and Procedure codes. This information can be found in the following document: What’s New in iEXCHANGE® for ICD-10 [pdf]

For ICD-10 code reference, a list of the 2016 ICD-10-CM valid codes is posted on the CMS website at http://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-CM-and-GEMs.html.

Please contact Provider Services with questions or issues.
Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

Submitting Other/Outpatient Waiver Requests Alert ~ Aug 13, 2015

When entering Other/Outpatient Requests for Waivers in iEXCHANGE, it is a requirement to enter a procedure code. The 99.9 procedure code has been used for all Other/Outpatient Requests for this purpose.

On Thursday evening, August 13, 2015 MEDecision will implement a system update which includes recent code updates in which code 99.9 has been removed from the valid codes list.

Going forward, please enter procedure code 99.99 when entering an Other/Outpatient Requests for Waivers request in iEXCHANGE.

We apologize in advance for any inconvenience.

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

Multiple Outcome Issue Alert ~ July 1, 2015

We would like to alert you to an issue related to 3808 retrospective reviews with split outcome results (split outcomes are hospital stays with approved and denied days). Delmarva has identified a defect in the MEDecision Aerial system related to some cases with split outcome results.  This defect causes the system at times to randomly re-sequence Delmarva’s decision that has been entered into the system, creating gaps in the review results.

Below is an example (Table A) of a decision that has been made by Delmarva and entered into the Aerial system. Following this example, is another example (Table B) of how the system re-sequences the case. A patient has a 28-day inpatient and receives the following determination from Delmarva:

Table A:

From Date

To Date

Days

 Outcome

1/2/2015

1/6/2015

4

Approve

1/6/2015

1/15/2015

9

Deny

1/15/2015

1/17/2015

2

Approve

1/17/2015

1/30/2015

13

Deny

The table below is an example of when the system randomly re-sequences the above decision. 

Table B:

From Date

To Date

 Days

Outcome

1/2/2015

1/6/2015

4

Approve

1/6/2015

1/8/2015

2

Approve

1/17/2015

1/30/2015

13

Deny

1/21/2015

1/30/2015

9

Deny

There is no system fix from MEDecision at this time so Delmarva will continue to use the manual work around to correct the entries when this issue occurs. Delmarva has implemented a manual check for these cases and while we make every attempt to catch all the cases before they are processed, it is possible a few cases will slip through our edits.

In the event you identify one of these cases and you are unable to process your claim, please contact Delmarva Provider Service at the number below and select Option 1 for Acute Care. When notified, we will process a correction on these cases as soon as possible.

We apologize in advance for any inconvenience.

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

Update on Levels of Care provided by Delmarva ~ April 2015

The Department of Health and Mental Hygiene has learned that there may still be some confusion regarding a recent variation in the response that Delmarva provides to hospitals and nursing facilities who request medical eligibility determinations for potential admissions to nursing facilities.   This bulletin is being issued to explain the variation.

One of Delmarva’s primary roles as the Department’s contractual Utilization Control Agent is to make determinations regarding whether an individual meets the criteria for medical eligibility for nursing facility services (aka “level of care”).  Until recently, Delmarva also provided information on the individual’s “reimbursement level”, i.e., whether the facility could be expected to be reimbursed at a light, moderate, or heavy care rate based solely on dependency in activities in daily living. This information was provided to better enable nursing facilities to determine the initial payment level. 

Starting 1/1/2015, Maryland Medicaid converted its reimbursement system from the previous resident-specific system to a single-rate RUGS-based system in which facilities are paid based on the overall case mix index. Because payment for care days is no longer resident-specific nor based on ADLs alone, Delmarva is no longer providing information on reimbursement level. Please note, however, that it is still necessary for hospitals and nursing facilities to obtain a nursing facility level of care for all new admissions, inter-facility transfers, and readmissions from hospitals when the stay exceeds 15 days.

We greatly appreciate your patience in this transition. If you have any questions, please feel free to contact:

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

iEXCHANGE Users Update ~ June 2014

Reminder: Providers can find the status of their submitted requests from the two search options available in iEXCHANGE.

Treatment Update Search - Providers should use the Treatment Update Search option to find requests that have had updates made by Delmarva Foundation in the past 10 days. 

Treatment Search - To locate all requests regardless of when the request was updated, providers should use the Treatment Search option. Treatment search provides various options to narrow your search results. 

Please download the iEXCHANGE Search Tip Sheet [pdf] for more information on using these search functions.

Please contact Provider Services with questions.

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

Sample Therapy Log for Utilization Review ~ Jun 02, 2014

A sample therapy log form [pdf] is now available that will help streamline the review of acute rehab cases. It is often difficult to locate the therapy times in the medical records provided for acute rehab review to determine if the minimum therapy guidelines have been met (at least 2 disciplines and ≥ 3h/d ≥ 5d/wk). Currently, two of the Acute Rehab hospitals in Maryland utilize a form similar to the one we have added to the Acute Care Resources site. This therapy log will enable the nurse reviewers to quickly verify that the recipient has indeed received intensive inter-disciplinary, coordinated rehabilitation services according to InterQual guidelines.

If you have any questions, please direct them to our Provider Support line at 866-571-3629.

iEXCHANGE® Browser Requirements ~ Mar 20, 2014

MEDecision only supports the following web browsers and versions when accessing iEXCHANGE:

  • Internet Explorer version 6.0, 7.0, 8.0 or 9.0
  • Firefox - All versions

Please note that using another browser or version not listed is not supported.

Providers should check the browser they are using. If using Internet Explorer, check the version to ensure it is listed above (from the IE menu bar select "Help...", then select "About Internet Explorer").

Alternatively, you may check your browser and version here: www.thismachine.info.

If you are not using a supported browser, you will need to contact your IT department or the individual that maintains and installs upgrades to your machine, and have the browser rolled back to a supported version.

Additionally, please note that using a higher version of the Internet Explorer browser in compatibility mode is also not supported.

Thank you in advance for your cooperation.

3808 Claims Extract Alert! ~ Mar 7, 2014

Delmarva has identified a technical issue related to completed claims that had not been assigned a UB04 number. This occurred with the claims extract on Monday, March 3, and Thursday, March 6. The issue has been resolved and the claims extract for this evening, Friday, March 7, will include the completed claims from March 3rd and 6th.

If you have any questions, please contact the Provider Support Line at (866) 571-3629.

Thank you for your patience.

Recommended Medical Records Packaging Procedures ~ Mar 4, 2014

Recommended packaging procedures for sending medical records to Delmarva when shipped through the mail or other ground transportation service:

  • Use of a box for medical records as the preferred packaging.  Priority mailing boxes, for example.
  • Use of a heavy-duty envelope such as the Tyvek ©, or the bubble-wrapped type.
  • Avoid over-packing.  Overstuffed boxes and envelopes are more susceptible to tearing.
  • Double wrap the contents (an envelope within an envelope).
  • Use of bubble wrap around the medical record to keep the record intact within an envelope.
  • Stamp or label Confidential.

Thank you for your cooperation,  

Please contact Provider Services with questions or comments.

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

Aerial - iEXCHANGE Upgrade Alert! ~ Feb 2, 2014

Delmarva Foundation’s upgrade to MEDecision’s Aerial 4.1 has been successfully completed and iEXCHANGE® is now available for Provider use.

Please note that the iEXCHANGE® upgrade will not have a major impact on how you enter requests for Delmarva Foundation. However, there are a few changes and enhancements that providers will see now that the implementation is complete.

Please see the documentation, What’s New in iEXCHANGE? [pdf] located on the Maryland Medicaid website to become familiar with the changes.

Please contact Provider Services with questions or problems.

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

Aerial - iEXCHANGE Upgrade Alert! ~ Jan 31, 2014

Delmarva Foundation will be upgrading to MEDecision’s latest version of Aerial 4.1 starting today Friday, January 31st. and continuing through the weekend. This is a major upgrade of the software which again is scheduled for today Friday, 1/31/14 at 4:30 pm EST to Monday, 2/3/14 at 8:00 am EST.

Please note that due to the upgrade iEXCHANGE will be unavailable throughout the weekend in order to complete this implementation.

All users should log out of the system
by 4:30 pm EST today
!

The iEXCHANGE upgrade will not have a major impact on how you enter requests for Delmarva Foundation. However, there are a few changes and enhancements that providers will see once the implementation is complete. Please see the documentation, What’s New in iEXCHANGE? [pdf] on the Maryland Medicaid website to become familiar with the changes prior to the upgrade on February 3rd.

We understand this may have an impact on the work that you or your staff may normally perform over the weekends.

Acute Care Requests:
Delmarva will allow a 1-2 day grace period related to Acute CSR/Pre-Auth requests and submission of clinicals for concurrent review due on February 3rd.

Keep in mind that for inpatient admissions on Friday, Saturday, and Sunday, the initial notification and clinical review is due by COB on Tuesday. And for inpatient admissions on Monday, the initial notification and clinical review is due by COB on Wednesday.

LTC MER Requests:
Please submit any LTC MER request by 4:00 pm today Friday, 1/31/2014 in order for Delmarva to process the LOC. If it is an urgent request, please call Provider Services and notify the staff.

Please contact Provider Services with questions or issues after the implementation.

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

New Temporary ID Request Form ~ Jan 14, 2014

On Wednesday, January 15, 2014, a new process will be implemented for submitting Maryland Medicaid Temporary Member ID Requests. These requests will now be submitted via a form on the Maryland Medicaid website. This process has been changed to provide efficiency for submitting and creating Temporary ID’s. Once available you should begin to use this method to submit all Temporary ID Requests. After Friday, February 7, 2014 requests will no longer be accepted through the phone line or fax.

NOTE: If you experience issues with the new online form, please submit your request via phone or the fax form [pdf]

The Temporary Member ID Request Form is currently accessible from the Maryland Medicaid website home page on Wednesday, January 15th. To access the form, you must have a login to our website. If this is your first time access login on the Maryland Medicaid Website, you will need to register to create an account to use the secure site - see instructions below. If you already have an account setup for using the Upload Medical Records or UB04 Lookup functions, this account will also be used to access the Temporary Member ID Request Form.

MDMA Website Self-Registration & Login Instructions [pdf]

LOC Requirements Associated with Bedhold ~ Dec 19, 2013

To clarify the Bedhold memo with regards to the need for a Level of Care, there are two aspects; Financial and Medical.

For Financial purposes, the Nursing Facilities (NF) will not be reimbursed during the time a resident is out of their facility. The memo does encourage the Nursing Facilities to re-admit previous residents. 

For Medical eligibility, the following decision tree applies:

  • If the patient has been in the Hospital for 15 days or less and is returning to the Same Nursing Facility – No Level of Care is required
  • If the patient has been in the Hospital for 15 days or less and is being discharged to a New Nursing Facility – A Level of Care is required
  • A Hospital stay of 16 days or more – A Level of Care is required
  • If the patient is either being admitted or returning to any Nursing Facility under Medicare as the primary payor – A Level of Care is NOT required

iEXCHANGE® 9.0 Upgrade Alert! ~ April 19, 2013
On Sunday, April 21st MEDecision will implement an upgrade to iEXCHANGE during the regular monthly maintenance. The maintenance and upgrade are scheduled from 12:00 pm to 4:00 pm EST at which time iEXCHANGE will be unavailable.

At this time the iEXCHANGE upgrade will not have any major impact on how you enter requests for Delmarva Foundation. However, for facilities processing LTC Level of Care requests, you should be aware that the format has changed for entering dates on the 3871b questionnaire. In the 3871b questionnaire you must enter dates in mm/dd/yyyy format, including the slashes. This is different from how the date entries were made previously and how they are entered in the Inpatient and Outpatient request form, which has not changed.

Please contact Provider Services with questions or issues after the implementation.

Delmarva Foundation Provider Services
Local: 410-770-3983
Toll Free: 1-866-571-3629

New Acute Care Resources! ~ March 18, 2013
X02 Coverage Group references, resources and DES 401 form are now available on our website. You can complete the DES 401 form online and then print and fax or mail with the medical record to Delmarva Foundation. Please visit the Acute Care section and review the X02 Coverage Group information.

If you have any questions, please direct them to our Provider Support line at 1-866-571-3629.

DHMH Bedhold Policy Memo Announcement! ~ Jul 12, 2012
In response to questions from providers regarding changes to Long Term Care Bedhold policy Delmarva Foundation for Medical Care has uploaded the memo from DHMH regarding the changes to our website.  Please visit the long term care section and review the memo [pdf].  If you have further questions please call our provider services line at 1-866-571-3629.

Attention ~ Upload Medical Records and UB04 Login ~ Jun 20, 2012
Effective Wednesday, June 20, 2012, the first time you access the Upload Medical Records or UB04 Authorization Number links on the Maryland Medicaid Website, you will need to register to use these website tools.  This change is required in order to improve our website security. The login information you are currently using to access these tools will no longer be active.

The system will step you through the self-registration process. Once you have registered and created your new username and password, you will use this to login and access these functions going forward. See the registration instructions [pdf] to get started!

If you have any questions, please direct them to our Provider Support line at 866-571-3629.

We apologize in advance for any inconvenience. Thank you!

DHMH 3808 Process Failure ~ May 17, 2012
Delmarva Foundation experienced issues processing 3808 data files from MEDecision on Tuesday and Wednesday evening. We are in the process of correcting the problem and expect to export a file to the Department of Health and Mental Hygiene this evening. The 3808 reviews completed 5/15, 5/16, and 5/17 will have UB04 numbers available tomorrow May 18, 2012. We apologize for the inconvenience. 

iEXCHANGE Ver 8.4 Upgrade Announcement! ~ Mar 14, 2012
On Sunday March 18th, an enhanced version of iEXCHANGE (version 8.4) will be implemented during the Monthly Maintenance Outage. With this new version, the providers will see a few changes to the application (Questionnaire (3871b) Printing and Improved Navigation) which are described in the following document:

If you have any questions, please direct them to our Provider Support line at 866-571-3629.

DHMH 257 Informational Announcement! ~ Feb 6, 2012
Please note that Delmarva Foundation will not certify a 257 using an Advisory Level of Care. If a Resident has an Advisory Level of Care, it is the Nursing Facility’s responsibility to submit a request for a NF LOC via the iEXCHANGE system.  Once a level of care has been granted by the UCA, the Nursing Facility can submit the required documents along with a 257 for certification. 

DHMH Revised 3871B & BIMS Announcement! ~ Dec 15, 2011
Effective January 1, 2012 facilities will be required to use the revised DHMH 3871B form and BIMS. The DHMH nursing home Transmittal 237, the revised 3871b, 3871B instructions, BIMS tool, and BIMS instructions are now posted on our website under the Long Term Care tab.

DHMH 3871B Announcement! ~ Dec 5, 2011
The Utilization Control Agent (Delmarva Foundation) for DHMH is requesting that all AERS, Hospitals and MDC providers submitting a DHMH 3871B for Medical Day Care Waiver Services include a current address for the participant. This information should be entered in the iEXCHANGE notes. The MMIS II system is not up to date with Medical Assistance participants' demographics and at times this has caused a denial or approval letter to be returned to the Division of Community Long Term Care.

Attention: New DHMH 257 Form! ~ Aug 4, 2011
To request hard copies of the DHMH 257 (in triplicate) please write or by fax to the attention of Ms. Kimberly Quick.  Please include your provider name, provider number and address with your request.

Ms. Kimberly Quick
Budget Specialist
Department of Health and Mental Hygiene
Office of Eligibility Services
201 West Preston Street, Room L-9
Baltimore, MD 21201

Phone: 410-767-6899
Fax: 410-333-5046 

Long Term Care Announcement ~ Jul 25, 2011
For all temporary ID request numbers, please use this template [pdf] to obtain the information before calling or faxing your request. This will assist Delmarva Foundation to process your request more efficiently. Thank you!

"Retrospective Review (3808)" Announcement ~ Mar 25, 2011
Until further notice, requests for corrections to a 3808 (whether processed by KePRO or Delmarva) can no longer be submitted thru iEXCHANGE. The Acute Hospital 3808 Correction Request Form [pdf] should be completed and faxed to Kaitlin Johnston at 888-513-1995.

Upon completion by Delmarva, the request will be sent to the State for further processing. Providers will receive the correction verification for KePRO cases via fax and for Delmarva cases via iEXCHANGE. Hospitals should not resubmit their claim until this verification is received.

"Contacting Delmarva" Announcement ~ Feb 24, 2011
During this implementation period and high call volume it is important that providers direct any questions regarding cases or the review process directly through Provider Services Line using the telephone numbers provided. This will ensure that we provide you with a timely response and  the correct resources to address your question or concern.

ALERT ~ Feb 11, 2011
Use the procedure code 99.9 for Other Requests Only!  The category "Other Request" includes all Medical Waiver Programs.

ALERT ~ Feb 7, 2011
Please submit all 3808 requests via iEXCHANGE.

ALERT ~ Jan 31, 2011
Because Medicaid recipients may have multiple ID numbers in the Medicaid eligibility files, it is necessary to ensure that the ID number presented to the provider can be matched back to the correct recipient. Therefore, please enter the full 11 digit Medicaid ID number that appears on the member’s ID card in the “MA Number on Card” field in your iEXCHANGE request. When searching for a treatment update (status of your request) both the original recipient MA # as well as the current MA # (if different from the original ID) will appear on the treatment update.

Attention ~ 3871B Reviews
If additional information is required please complete the Additional Information Form and fax to Delmarva at 888-513-2002.

Educational Information

Please visit our training center, where you can select from a number of presentations that will describe what the transition to Delmarva as the Utilization Control Agent means for providers.