MedicaidAdministrativeHigh impact
Summer 2022 General Provider Updates
Maryland Medicaid·MD · OB-GYN, Family Medicine, General Practice +4 more·Provider Transmittal
Effective date
Sep 1, 2022
We identified it
Jun 20, 2026
Summary
Maryland Medicaid implements multiple updates effective at different dates: (1) Ordering/Referring/Prescribing (ORP) practitioner NPI requirements for Labs, Home Health, Portable X-Ray, DME/DMSS, and Diagnostic Services claims starting September 1, 2022 with mandatory active individual practitioner enrollment; (2) New coverage for doula/birth worker services (effective February 21, 2022) and expanded home visiting services (effective January 13, 2022); (3) Dialysis services monitoring to prevent routine dialysis billing in hospital emergency departments; (4) EID program income limit elimination effective October 1, 2022; (5) Postpartum coverage expansion to 12 months (effective April 1, 2022); and (6) PERM medical record review audits for SFY 2022 claims with recoupment penalties for non-compliance.
Action Required
REQUIREMENTS:
BY SEPTEMBER 1, 2022 (CRITICAL DEADLINE):
- Billing team must update billing system to require active individual practitioner National Provider Identifier (NPI) on ALL claims submitted for the following provider types: Labs, Home Health Aide/Private Duty Nursing, Portable X-Ray, Durable Medical Equipment/Disposable Medical Supply Providers, and Diagnostic Services.
- Verify that all referring practitioner NPIs belong to actively enrolled Maryland Medicaid individual practitioners (not group or facility NPIs, and not dummy/placeholder NPIs) using the Provider Verification System (PVS) at health.maryland.gov/providerinfo.
- Implement system edits to DENY claims missing required ORP practitioner NPI or containing inactive/invalid NPIs. Do not submit claims without compliant NPI information.
- Contact ePREP call center at (844)-463-7768 or visit ePREP.health.maryland.gov to enroll any ORP practitioners not yet registered with Maryland Medicaid. Prepare enrollment applications immediately.
- Update billing workflow documentation and train all billing staff on new requirements. Failure to include valid active ORP practitioner NPIs will result in automatic claim denials and potential payment recoupment.
IMMEDIATELY:
- Implement monitoring to ensure routine, non-emergent dialysis services are NOT billed to Maryland Medicaid when performed in hospital emergency departments. Redirect dialysis claims to free-standing facilities only. Prior improper dialysis billing may trigger recoupment actions.
- Establish process to respond promptly to any PERM (Payment Error Rate Measurement) Medical Record Request (MRR) letters. Designate staff to gather and submit complete medical record documentation within requested timeframes. Non-response or incomplete submissions will result in improper payment citations and potential recoupment/provider suspension.
- If enrolling new doula/birth worker providers or home visiting service (HFA/NFP) providers, ensure compliance with Maryland Medicaid certification and participation requirements per PT 37-22 and PT 35-22.
ONGOING:
- Monitor for policy updates regarding new covered services (doula services, home visiting services, expanded postpartum coverage) to ensure claims are coded and billed appropriately starting from effective dates.