MedicaidAdministrativeMedium impact
Clarification of Primary Care Provider Site Visit Requirements During Credentialing for HealthChoice Managed Care Organization Networks
Maryland Medicaid·MD·Managed Care Organizations
Effective date
Aug 12, 2024
We identified it
Jun 20, 2026
Summary
Maryland's HealthChoice MCO program clarifies that Primary Care Providers must undergo site visits during credentialing and recredentialing to verify EPSDT certification, recordkeeping practices, ADA compliance, and office accessibility. MCOs and delegated entities must document these site visits and maintain records of findings. This policy applies to all PCPs joining or continuing in HealthChoice MCO provider networks.
Action Required
REQUIREMENTS:
- Effective immediately (August 12, 2024): Billing and credentialing teams must ensure all PCP credentialing and recredentialing processes for HealthChoice MCO networks include mandatory site visits.
- Credentialing staff must verify and document the following before PCPs are added to network: (1) EPSDT certification status, (2) Recordkeeping practices for referrals and HealthChoice participant outcomes, (3) ADA compliance including physical access, reasonable accommodations, and accessible equipment, (4) MCO-specific network participation standards.
- Maintain complete documentation of all initial site visits to PCP offices, including visit dates, reviewed items, and findings per COMAR 10.67.05.05 standards.
- Billing team should coordinate with credentialing to ensure no claims are processed from PCPs who have not completed required site visit verification.
- If delegating credentialing to vendors or subcontractors, verify they understand and comply with these site visit requirements and documentation standards.
- Consequences of non-compliance: PCPs may not be properly credentialed; claims from non-credentialed providers may be denied; MCO may face compliance violations.