MedicaidBilling CodesHigh impact
Health Homes Services Integration with Carelon Behavioral Health
Maryland Medicaid·MD · Psychiatry·Behavioral Health Administration Services Organization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Maryland Medicaid is transitioning Health Homes behavioral health services from eMedicaid to Carelon Behavioral Health's system effective January 1, 2025. Providers must use new W1762 codes with H1-H6 modifiers for encounter documentation and submit claims using W1761 procedure codes. The authorization process and service requirements remain unchanged, but the billing and claims submission workflow will shift to Carelon's platform.
Action Required
By December 31, 2024: Billing team must obtain Carelon system access and submitter ID (BHOMD) for electronic billing clearinghouses. Update all billing software and encounter forms to require W1762 codes with corresponding H1-H6 modifiers (H1=Comprehensive Care Management, H2=Care Coordination, H3=Health Promotion, H4=Comprehensive Transitional Care, H5=Individual and Family Support, H6=Referral to Community and Social Support). Train all clinical and billing staff that: (1) For services on/before Dec 31, 2024, continue using eMedicaid and eClaims; (2) For services on/after Jan 1, 2025, document encounters using new W1762 code with appropriate H modifier; (3) Submit W1761 claims no later than 30 days from month-end using Carelon system; (4) W1761 claims will be DENIED without corresponding two W1762 codes validating the encounter types. Update authorization request templates to confirm clinical and social outcome measures documentation at initial and concurrent 6-month intervals. Direct questions to mdh.healthhomes@maryland.gov.