MedicaidAdministrativeMedium impact
Clarification of Timeframe Measurement for HealthChoice Enrollee Grievances, Appeals, and Authorizations
Maryland Medicaid·MD·Provider Transmittal
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
This policy clarifies how HealthChoice MCOs in Maryland must measure timeframes for processing enrollee grievances, appeals, authorizations, and notifications. MCOs may now treat 24-hour turnaround as one calendar day and 72-hour turnaround as three calendar days, aligned with federal regulations and NCQA standards. Timeframes are measured from receipt of the request to the date of MCO decision or notification.
Action Required
Immediately: Billing and prior authorization teams must review current timeframe tracking processes for HealthChoice enrollee grievances, appeals, and authorization requests. Implement 24-hour = 1 calendar day and 72-hour = 3 calendar day conversion standards in tracking systems and audit documentation. Verify that all grievance, appeal, and authorization response timelines are measured from request receipt date to MCO decision/notification date. Update internal audit procedures to reflect this measurement methodology. No workflow changes required if already compliant with federal regulations and NCQA standards.