If you’re a healthcare provider in Maryland and need to correct a previously submitted claim to the Medical Assistance Program (Maryland’s Medicaid program), you’ll need to complete and submit a DHMH 4518A form. This comprehensive guide provides step-by-step instructions for filing a Maryland Medical Assistance claim adjustment, covering scenarios such as incorrect payments, overpayments, and refunds. Understanding how to properly utilize the Medicaid adjustment form Maryland uses is crucial for accurate billing and reimbursement.

The DHMH 4518A Adjustment Request Form is essential for rectifying payment discrepancies. You can find the most current version of the form directly from the Maryland Department of Health here: Maryland Department of Health DHMH 4518A Form (PDF). We recommend reviewing this form and associated guidelines on the official Maryland Department of Health website quarterly to ensure all information, including contact details, remains current and accurate.

Why You Might Need to File a DHMH 4518A Claim Adjustment

There are several common reasons why a provider might need to submit a Maryland Medical Assistance claim adjustment. These include, but are not limited to:

• Incorrect Payment Received: You were paid, but the amount was incorrect (e.g., underpayment or overpayment).
• Third-Party Payment: You received payment from a third party after Medical Assistance (Maryland’s Medicaid program) had already made a payment.
• Keying Errors: Mistakes made by the Medical Assistance program during claim processing.
• Incorrect Units Billed: You billed for an incorrect number of units of service.
• Coding Errors: Incorrect CPT, HCPCS, or ICD-10 codes were submitted.
• Changes in Patient Eligibility: A patient’s eligibility status changed retroactively.
• Retroactive Coverage: The patient gained coverage retroactively for a service already billed.
• Missing Information: Initial claim lacked necessary documentation.

Step-by-Step Guide to Completing and Submitting the DHMH 4518A Adjustment Request Form

Follow these detailed steps to accurately complete and submit your DHMH 4518A form for a Maryland Medical Assistance claim adjustment:

1. Obtain the Form: Download or print the latest DHMH 4518A Adjustment Request Form from the Maryland Department of Health website. (The link is provided above for your convenience.)
2. Identify the Claim: Clearly identify the original claim that requires adjustment. Have the original remittance advice and claim form (e.g., CMS-1500) readily available.
3. Complete Provider Information: Fill in all required provider details accurately on the form.
4. Specify Reason for Adjustment: Clearly state the reason for the adjustment. Be specific about what needs to be corrected (e.g., “Incorrect units billed – originally 3, should be 5,” “Coding error – CPT code X changed to Y,” “Retroactive eligibility”).
5. Enter Original and Corrected Amounts/Units:
   • If an incorrect payment was due to a keying error by Medical Assistance or incorrect units billed, do not bill only for remaining unpaid amounts or units. Instead, bill for the entire correct amount(s) or units.
   • Example: If you originally submitted and received payment for three units but should have billed for five units, do not bill for the remaining two units; bill for the full five units on the adjustment form.
6. Handle Refunds (Total vs. Partial):
   • Total Refunds: If every claim payment on a remittance advice is incorrect (i.e., none of the recipients are your patients), return the entire check issued by the Medical Assistance Program. Include a copy of the remittance advice, the check, and a complete Adjustment Request Form.
   • Partial Refunds: If a remittance advice lists some correct payments and some incorrect payments, do not return the Medical Assistance Program check. Deposit the check and then file an individual Adjustment Request Form for each claim paid incorrectly.
   • Note: For overpayments or refunds, a single provider check may be submitted to cover more than one Adjustment Request Form.
7. Attach Supporting Documentation: Always attach any necessary supporting documentation, such as copies of remittance advices, the original CMS-1500 claim forms, or other relevant records.
8. Review and Verify: Before mailing, carefully review the entire form and all attachments for accuracy and completeness. Ensure all fields are filled out correctly and consistently.
9. Mail the Form: Send the completed Adjustment Request Form and supporting documents to the designated address.

Where to Mail Your Maryland Medical Assistance Claim Adjustment Forms (DHMH 4518A): P.O. Box 13045 Baltimore, MD 21203

Medical Assistance Adjustment Unit
P.O. Box 13045
Baltimore, MD 21203

For any questions or concerns regarding your Medicaid adjustment form Maryland submission or general inquiries about the Maryland Medical Assistance claim adjustment process, you can contact the Adjustment Unit directly at 410-767-5346.

Frequently Asked Questions (FAQ) about Maryland Medical Assistance Claim Adjustments

What is the timeframe for submitting a DHMH 4518A adjustment request?

While specific timeframes can vary, generally, providers are expected to submit adjustment requests promptly. It’s best to consult the latest official Maryland Department of Health billing manuals or contact the Adjustment Unit for precise, up-to-date deadlines. Providers typically have 12 months from the date of service to submit claims and adjustments, but this can vary depending on the specific program and circumstances.

What are common reasons for denial of a DHMH 4518A adjustment request?

Common reasons for denial include incomplete forms, missing supporting documentation, unclear justification for the adjustment, attempting to adjust a claim that is outside the timely filing limit, or errors in calculating the adjustment amount. Always ensure all fields are correctly filled and all required attachments are included.

How can I track the status of my Maryland Medical Assistance adjustment request?

The primary method for tracking the status of your adjustment request is often through your remittance advices, which will reflect any processed adjustments. For specific inquiries or if you don’t see the adjustment reflected, contact the Adjustment Unit directly at 410-767-5346, providing all relevant claim and adjustment request numbers.