Maryland Medicaid: Balance billing is not permitted
AI Summary
Maryland Medicaid providers are prohibited from balance billing members for any reason, including when charges exceed fee schedules, claims are denied, or during claim reviews. Providers must verify eligibility before services and can only collect permitted cost-sharing amounts.
Action Required
Immediately: Billing team must stop all balance billing for Maryland Medicaid members. Update billing system rules to prevent balance billing when charges exceed fee schedules or claims are denied. Front desk staff must verify member eligibility before each service and inform patients of coverage status. Only collect Maryland Medicaid-permitted cost-sharing amounts. Bill other insurance carriers first before Maryland Medicaid. Violation may result in payment recoupment, sanctions, or program termination.
Plan Types
Medicaid
States
MD
Specialties
all-specialties