Maryland Medicaid Provider Billing FAQs: Claims, Eligibility & Policies

Last Updated: May 15, 2024

Disclaimer: Maryland Medicaid policies and guidelines are subject to change. Providers should always cross-reference this information with the latest official Maryland Department of Health Medicaid resources for the most accurate and up-to-date guidance.

Maryland Medicaid Provider Contact Information

For immediate assistance with claims status or other provider inquiries, please contact Provider Relations:

• Phone: 410-767-5503 or 1-800-445-1159 (Toll-Free)
• Hours: Monday – Friday, 8:00 AM – 5:00 PM

Welcome to our comprehensive Frequently Asked Questions (FAQs) guide specifically designed for Maryland Medicaid providers. Here, you’ll find essential answers concerning Maryland Medicaid provider billing, claims status, provider eligibility verification, and policies such as Maryland Medicaid’s missed appointment policy. Our aim is to help you navigate common billing scenarios and ensure compliance with Maryland Medicaid’s guidelines.

1. When can a Maryland Medicaid provider bill a recipient?

A Maryland Medicaid provider can bill a recipient only under the following specific circumstances:

• If the service provided is not covered by Maryland Medical Assistance and you have clearly notified the recipient prior to providing the care that the service is not covered. This notification should ideally be documented, such as through a signed waiver, a written communication, or a documented conversation, detailing the non-covered service and the recipient’s financial responsibility.
• If the EVS (Eligibility Verification System) reported a message indicating that the recipient was not eligible for Maryland Medical Assistance on the exact date you provided services. This confirms a lack of coverage for that specific encounter.

2. Can a provider bill Maryland Medicaid recipients for a missed appointment?

No. Federal policy, which applies to the Medicaid missed appointment policy Maryland, strictly prohibits providers from billing Maryland Medicaid recipients for any missed appointments. This policy is outlined in official Medicaid guidance. For detailed information on this policy, providers should refer to **official Maryland Medicaid transmittals regarding missed appointments**.

3. How can a Maryland Medicaid provider check the status of claims?

To inquire about Maryland Medicaid claims status, Provider Relations representatives are available Monday through Friday. You can reach a representative by calling 410-767-5503 or 1-800-445-1159 between 8:00 AM – 5:00 PM.

4. How can a Maryland Medicaid provider obtain a copy of a Remittance Advice (RA)?

Copies of Remittance Advice (RAs) for Maryland Medicaid claims are typically available for up to two years by accessing the Program’s website, often through platforms associated with **Maryland Medicaid managed care organizations** or the state’s provider portal. eMedicaid registration must typically be completed by an Administrator to access these documents. To request an eMedicaid brochure or for further assistance, please call the Provider Training and Liaison Unit at 410-767-6024. For RAs older than two years, you may call a representative at 410-767-5503 between 8:00 AM – 5:00 PM.

5. How can a Maryland Medicaid provider request a check tracer?

You may request a check tracer for Maryland Medicaid payments by calling Provider Relations at 410-767-5342 between 8:00 AM to 4:30 PM.

6. How can a Maryland Medicaid provider request training for paper billing?

The Provider Training and Liaison Unit offers quarterly trainings for Maryland Medicaid providers, including sessions on paper billing. To register for training, call 410-767-6024 or visit the official Maryland Department of Health Provider Training page to view the schedule and registration form.

7. Can a provider verify Maryland Medicaid eligibility for future dates?

No, the Eligibility Verification System (EVS) for provider eligibility verification Maryland does not allow checking for future dates. However, you can use EVS to check for past eligibility up to one year prior.

8. What is the timely filing limit for Maryland Medicaid claims?

A Maryland Medicaid provider has nine months from the date of service to submit a claim for payment. For other time statutes and exceptions, please refer to the comprehensive **Maryland Medicaid billing manual**.

9. What is the mailing address for Maryland Medicaid claims?

Paper claims for Maryland Medicaid should be mailed to the following address:

Claims Processing
P.O. Box 1935
Baltimore, MD 21203

10. How long should a Maryland Medicaid provider wait before checking paper claim status?

Under normal processing conditions for paper claims, it is advisable to wait six weeks from the mailing date before contacting Provider Relations to inquire about your Maryland Medicaid claim status.

Key Takeaways for Maryland Medicaid Providers

• Always verify recipient eligibility before providing services.
• Billing recipients directly for covered services or missed appointments is prohibited by Maryland Medicaid policy.
• For quick assistance with claims or eligibility, utilize the dedicated Provider Relations phone lines.
• Stay informed about the latest Maryland Medicaid policies by regularly checking official Maryland Department of Health resources.
• Accurate and timely filing is crucial for proper reimbursement.