MedicaidPrior AuthMedium impact
Clarification of HealthChoice MCO Timelines for Pharmacy Preauthorization Decisions
Maryland Medicaid·MD·Managed Care Organizations
Effective date
Oct 3, 2024
We identified it
Jun 20, 2026
Summary
Maryland HealthChoice MCOs must now issue preauthorization decisions for covered outpatient drugs within 24 hours of request. If additional information is needed, providers have up to 14 calendar days total to submit required documentation for final approval or denial decision.
Action Required
Immediately: Billing and pharmacy teams must adjust expectations for Maryland HealthChoice MCO drug preauthorization responses - expect decisions within 24 hours. Update workflow to respond quickly to requests for additional information, as the 14-day submission window includes the original 24-hour period. Train staff to follow up if decisions are not received within 24 hours.