MedicaidAdministrativeMedium impact
Clarification of Medicaid Provider Enrollment for Self-Referred Services
Maryland Medicaid·MD · Family Medicine, OB-GYN, Pediatrics·Provider Transmittal
Effective date
Apr 4, 2024
We identified it
Jun 20, 2026
Summary
Maryland Medicaid clarifies that providers offering self-referred services (family planning, school-based health center services, COVID-19 lab tests) do not need to participate in MCO networks but MUST enroll as participating Medicaid providers through ePREP to receive reimbursement at the Medicaid fee-for-service rate. This is a clarification of existing regulation (COMAR 10.67.06.28), not a new requirement.
Action Required
Verify that all providers in your practice offering self-referred services (family planning, school-based health center services, COVID-19 laboratory tests) are enrolled as participating Medicaid providers through ePREP. Billing team should confirm current enrollment status for relevant providers at https://health.maryland.gov/mmcp/provider/Pages/enrollment.aspx. If providers are not enrolled, initiate enrollment immediately to ensure claims for self-referred services are processed at the Medicaid fee-for-service rate. No MCO network participation is required for these services, but Medicaid enrollment is mandatory. Contact mdh.healthchoiceprovider@maryland.gov with enrollment questions.