Medical billing services in Maryland

Billing in Maryland: what's different

The rules below change how a claim is filed and paid in Maryland. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.

Rules that change how Maryland claims are billed

• Telehealth takes modifier GT or UB with the usual place of service, never POS 02 or 10 on Medicaid-only claims¹²

  The May 2025 Maryland Medicaid Telehealth Program Policy Guide wants modifier GT on a procedure code delivered by audio-visual telehealth and modifier UB for audio-only, with the place of service the practice would use for an in-person visit, based on the rendering practitioner's location (an off-site office is POS 11). Place of service 02 and 10 are not used on Medicaid-only fee-for-service claims; they are allowed only on Medicare crossover claims, where the Medicaid claim mirrors the Medicare one. Audio-only coverage is program-specific, consent is obtained and documented unless an emergency prevents it, and a session interrupted by technical failure, a store-and-forward service or a service that needs in-person evaluation cannot be billed.

• Who stays out of HealthChoice, and so bills fee-for-service¹³

  HealthChoice does not enroll people 65 and over, anyone on Medicare, spend-down eligibles, people in limited-benefit programs such as Maryland Family Planning, residents of intermediate care facilities, Model Waiver participants, anyone expected to need more than 90 days of long-term care, people institutionalized in a facility for mental disease for 30 days or more, or Rare and Expensive Case Management participants. For a practice that means two claim streams for the same Medicaid logo: the MCO's portal and rules for most patients, and eMedicaid or an 837 to the state for the excluded groups.

• CareFirst and UnitedHealthcare file Maryland rates under several legal entities¹⁵

  The Maryland Insurance Administration's briefing on 2024 ACA rates, given to the House Health and Government Operations Committee on October 5, 2023, lists each rate filing by legal entity. Its individual market exhibit subtotals CareFirst BlueChoice, CareFirst GHMSI and CareFirst CFMI together as CareFirst, and its small group exhibit lists United Healthcare of the Mid-Atlantic, United Healthcare (Optimum Choice), United Healthcare (MAMSI) and United Healthcare Insurance Co. as one carrier's filings. Several names in the commercial payer list above therefore belong to the same two carriers, which is why the list shows the brand beside each filing name.

• EVV for home health and private duty nursing comes with a one-year limit and six manual time records a month¹¹

  The LTSSMaryland Provider Billing Support Office policies for home health and private duty nursing, effective November 9, 2023 under COMAR 10.09.36.03-2, require every direct service professional, including temporary staff, to have a staff profile with a valid SSN or ITIN in the Provider Portal before the first visit and to clock in and out through the LTSSMaryland EVV mobile app, falling back to the ISAS telephone line only from a phone number authorized in the participant's profile. MDH approves no more than six manual time records per clinical staff member per month without a verifiable excuse, no claim is paid or adjusted more than a year after the date of service, overpayments must be repaid, and the EVV work week runs Thursday to Wednesday.

• eMedicaid is where eligibility, payment information and the remittance advice live¹⁴

  The Maryland eMedicaid Portal, brought to providers by the Maryland Department of Health, describes itself as secure online services for Maryland Medicaid providers to verify recipient eligibility and obtain payment information and the remittance advice. Its home page also carries the eCLAIM overview and tutorial, the Medicare Part B crossover claim submission user guide, the UB04 Part A user guide, the EVS help page and the HIPAA companion guides, so the eligibility check before the visit, the fee-for-service claim and the posting of the remittance all sit behind one login. Enrollment, re-enrollment and revalidation run through MPRIME, the portal in the table above, so a new clinician has two accounts to clear before the first clean claim is filed and posted.

• Grantees pick the cheapest safe ride, and a higher level of transport needs a physician's documentation⁸

  COMAR 10.09.19.04 obliges each transportation grantee to serve Medical Assistance recipients, and their attendants when necessary, who have no other means of transportation, and to do it in the most efficient and cost-effective manner possible, using volunteers and charitable organizations whenever it can. A recipient moves off public transportation only when a physician documents that the medical condition makes it medically contraindicated. For a clinic that books rides for Medicaid patients, that note is what turns a bus pass into a van, and it belongs in the chart before the trip is requested.

Services for Maryland practices

Remitwright serves Maryland practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.

• Medical billingClaims worked by one named biller
• CredentialingEnrollment, CAQH and PECOS kept current
• Eligibility verificationCoverage and benefits checked before visits
• Prior authorizationAuths requested, tracked, attached to claims
• Denial managementEvery denial read, worked and appealed
• A/R follow-upUnpaid claims chased before filing limits