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    Office of Medical Assistance Programs (OMAP)

    Bureau of Fee-for-Service Programs

    The Bureau of Fee-for-Service Programs (BFFSP) administers most provider-related operational components of the traditional Medicaid program.

    Bureau activities include: administration of provider screening and enrollment across the entire Medicaid and CHIP programs, administration of provider and recipient call centers for inquiries and technical assistance, clinical review for authorization of services covered under the FFS delivery system including inpatient and outpatient hospitals, ambulatory surgical center and facility services, and authorization of those services/items as designated on the Medical Assistance (MA) fee schedule. The Bureau also administers the MA covered drug program;  and administers an Intense Medical Case Management program for individuals in the FFS delivery system who have complex medical needs.  

    Divisions

    This division performs medical and automated utilization reviews of authorization requests for hospital admission and continued stays to authorize and ensure medical necessity of services. In addition, the division performs medical review of prior authorization requests for durable medical equipment, outpatient laboratory, radiology, and other diagnostic services, home health and shift care as well as those for Place of Service for elective admissions to hospitals, ambulatory surgical, and short procedure units. 

    • Division Chief: Lindsey Shover

    This division oversees and administers the Provider and Recipient Call Centers and develops communication strategies for recipients and providers for MA Program changes and related call center messaging. The division also resolves PROMISe claim payment questions and assists in development of provider billing and companion guides. In addition, the division oversees FFS-related special project areas including 180-day exceptional claims processing, delinquent account resolution, and dental services.

    • Do you need assistance?
      Call the BFFSP Service Center at 1-800-537-8862. 
      Hours: Monday-Friday, 8 a.m.-4:30 p.m.
      Participants: Select Option 2 > then 6 > then 1
      Providers: Select Option 1 > then 2 > then 3

    This division is responsible for developing and submitting Advance Planning Documents to CMS and tracking of the enhanced federal funding initiatives. In addition, this division must monitor, track and project the state and federal budget and funds for MMIS related activities and ensure vendors are meeting their contractual obligation: and is the lead to identify requirements and priorities with the MMIS vendor and BIS on the CMS mandated T-MSIS reporting.

    • Email: RA-provapp@gov
    • Do you need enrollment assistance?
      Call the BFFSP Service Center at 1-800-537-8862. 
      Hours: Monday-Friday, 8 a.m.-4:30 p.m.
      Select Option 2 > then 4

    This division administers the MA covered drug program including drug utilization management, provider call center for drug prior authorizations and billing issues for FFS beneficiaries, Statewide Preferred Drug List (PDL), drug rebate program, and Specialty Pharmacy Drug Program and oversees drug coverage requirements under the MA managed care program.

    • Do you need pharmacy services assistance?
      Call the Pharmacy Service Help Desk:  1-800-537-8862 
      Hours: Monday-Friday, 8 a.m.-4:30 p.m.

    This division case manages certain individuals in the FFS delivery system who have complex medical and/or surgical needs, including certain aliens eligible for coverage under Emergency Medical Assistance (EMA), and coordinates care with FFS providers and other DHS offices.

    • Do you need assistance?
      Call the BFFSP Service Center at 1-800-537-8862. 
      Hours: Monday-Friday, 8 a.m.-4:30 p.m.
      For Intense Medical Case Management assistance, select Option 2 > then 5 

    Bureau Information

    Director

    • Michele Robinson

    Contact Information

    BFFSP Service Center

    Call the BFFSP Service Center

    By calling 1-800-537-8862, the BFFSP Service Center can offer assistance with services such as provider enrollment and screenings, PROMISe technical assistance, clinical review and authorization, pharmacy service, Intense Medical Case Management.