MedicaidPrior AuthHigh impact
Clarification of Medicaid Payor Responsibility for Inpatient Care and Services Requiring Preauthorization
Maryland Medicaid·MD·Hospital
Effective date
Jun 4, 2024
We identified it
Jun 20, 2026
Summary
Maryland Medicaid clarifies that preauthorizations expire when patients transition between fee-for-service and managed care plans, requiring new authorization requests to the current payor. For inpatient stays, the payor at admission remains responsible for facility fees until discharge, while professional fees split based on enrollment dates.
Action Required
Immediately: Billing team must establish workflow to verify current Medicaid payor type (FFS vs MCO) before submitting authorization requests. Update system to flag when Maryland Medicaid patients transition between payors during treatment. For inpatient cases, split billing appropriately - submit facility fees to admission-date payor and professional fees to current payor. Train staff that old authorizations expire upon payor transitions and new ones must be obtained from current payor.