MedicaidAdministrativeHigh impact
Billing Policies for "128 - Beyond Statute" Denial Code
Maryland Medicaid·MD · Geriatrics·Nursing Home
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Summary
Maryland Medicaid reactivated the '128 - Beyond Statute' denial code effective October 1, 2024, requiring nursing home providers to submit claims with dates of service beyond 12 months from the date of service on paper (not electronically) to the Institutional Provider Resolution Unit. Claims submitted beyond 12 months now require Long Term Care Provider Resolution Unit (LTCPRU) approval before billing, and providers must submit approved claims within 60 days or face denial.
Action Required
By March 31, 2025 (to ensure compliance with the 1-month-old policy): Billing team must implement the following workflow changes: (1) Configure billing software to automatically flag and reject electronic submissions for nursing home claims with dates of service beyond 12 months from current date—these must be rerouted to paper submission process; (2) Create a mandatory checklist requiring all paper submissions for beyond-12-month claims to include LTCPRU approval notice and all applicable required documents before sending to Provider Service - Institutional Provider Resolution, PO BOX 22751, Baltimore, MD 21203; (3) Establish a 60-day countdown tracking system from LTCPRU approval date to ensure claims are billed within the window—set alerts at days 30 and 55 to prevent missed deadlines; (4) Update staff training to distinguish between claims within 12 months (standard PO BOX 1935 submission) and beyond-12-month claims (paper-only to PO BOX 22751); (5) Designate an 'Institution Designated Point of Contact' for LTCPRU communications via Cognito portal to receive approval/denial notices. Failure to comply will result in claim denials with 128 - Beyond Statute code and non-reimbursement.