310/Maryland Manual

DIVISION OF CLAIMS PROCESSING
John F. D. Bowersox,AH»jt»»t.Dwwtw
225-5347

The Division of Claims Processing originated as
the Division of Invoice Processing and received its
present name in Fiscal Year 1990. The Division
processes all claims for payment made by providers
of health care services under the Medical Assistance,
Pharmacy Assistance and Prenatal Assistance
Programs from the date they are received until they
are destroyed two years later. Processing includes
mail sorting, microfilming, entry of claims into the
Medicaid Management Information System Batch
and Invoice Control File, and processing of pay-
ments in excess of $900 million annually for 10
million claims received. The Division maintains
records of payments to, as well as collection from,
the more than 25,000 health care providers en-
rolled in the Medical Assistance Program. The
Division also serves as a centralized purchasing and
inventory unit for the Administration.

DIVISION OF ELIGIBILITY SERVICES
John P. Steward, Assistant Director
225-5406

The Division of Eligibility Services, formerly the
Division of Programs and Liaison, received its
present name in Fiscal Year 1990.

DIVISION OF MEDICAID INFORMATION
SYSTEMS
Alan R. Shugart, Assistant Director
225-5408

Established in 1982, the Division of Medicaid
Information Systems serves as the data processing
unit for Medical Care Programs. The Division per-
forms systems analysis and programming and main-
tains a teleprocessing network. It maintains and
operates the Medicaid Management Information
System (MMIS), an automated claims processing
and information retrieval system mandated by the
federal government. Data processing for the Phar-
macy Assistance Program, Geriatric Evaluation Ser-
vices (GES), and Statewide Evaluation and Planning
Services (STEPS) is provided by the Division.

DIVISION OF SPECIAL PROGRAMS
Dawn L. Grosshandler,Ai!Mt»w.D(rc(Wr
225-5000

The Division of Special Programs includes the
Kidney Disease Program and the invoice processing
component for the Children's Medical Services Pro-
gram of the Local and family Health Administration.
The Kidney Disease Program began in 1971. It
assists Marylanders who have end-stage renal dis-
ease with State payment of part or all of the cost of
treatment.

MEDICAL CARE POLICY
ADMINISTRATION

Joseph M. Millstone, Director
John G. Folkemer, Deputy Director

201 W Preston St.
Baltimore, MD 21201 225-1432
225-5206

The Medical Care Policy Administration
originated as the Policy Administration. In 1987,
the Policy Administration was renamed as the
Health Systems Financing Administration. The Ad-
ministration received its present name in March
1990.
The Administration reviews and develops
Medicaid policies and regulations that establish
eligibility criteria, define services, detail coverage,
specify limitations, and determine reimbursement
rates. In addition, it maintains an up-to-date State
Plan and obtains federal approval for program
changes to assure the continued availability of
federal matching funds.
The Administration works through nine divisions:
LongTcrm Care; Acute Care; Primary Care; Maternal
and Child Health; Community Support Services;
Administrative Services; Eligibility Services; Aging
Services; and Program Services.

DIVISION OF LONG-TERM CARE
Mark A. Leeds, Chief
225-1442

The Division of Long-Term Care was organized
in July 1979. The Division administers Maryland
Medicaid coverage and reimbursement for nursing
home services, medical day care, and personal care.

DIVISION OF ACUTE CARE
Patricia C. Burkholder, Chief
225-1455

Established in July 1979, the Division of Acute
Care administers all aspects of planning, prepara-
tion of and amendments to regulations, and inter-
pretation of policy for the following parts of the
Maryland Medical Assistance Program: Hospitals,
Medical Laboratories, Residential Treatment
Centers, Pharmacy, and Free-standing Dialysis
Centers.

DIVISION OF PRIMARY CARE
Donald Engvall, Chief
225-1482

The Division of Primary Care was formed in July
1987. The Division establishes and articulates the
State's Medicaid policies and regulations pertaining
to medical and professional services. Addressing the
primary medical care needs of individuals, these
services are provided direcdy to recipients on an