MedicaidAdministrativeHigh impact
Clarification on Timely Filing Requirements for Retrospective Reviews and Claims Submissions
Maryland Medicaid·MD·Provider Transmittal
Effective date
Oct 12, 2021
We identified it
Jun 20, 2026
Summary
Maryland Medical Assistance Program clarified timely filing requirements for retrospective (3808) reviews and claims submissions. For retrospective reviews over one year old, hospitals must now submit proof of patient eligibility determination date (DHR/IMA-81 or NOE form) to Telligen within 20 calendar days or face technical denial. For claims submissions, providers have 12 months from eligibility determination date to submit claims; those beyond 12 months require paper submission with a cover letter to the Provider Resolution Unit for review and consideration.
Action Required
REQUIREMENTS:
Immediately: Billing and claims teams must implement the following procedures:
1. For Retrospective (3808) Reviews:
- Update internal processes to require proof of patient eligibility determination date (DHR/IMA-81 or Notice of Eligibility form) for ALL retrospective reviews submitted to Tellingen that are more than one year past discharge date.
- Establish tracking system to monitor the 20 calendar day deadline for submitting eligibility documentation to Telligen.
- Document this requirement in billing software and staff training materials.
- Consequence: Failure to submit eligibility proof within 20 days will result in technical denials.
2. For Claims Submission:
- Update billing software to flag claims for retroactive eligibility determinations.
- Establish two submission pathways in billing system:
a) Claims within 12 months of eligibility determination date: Submit electronically per normal processing, but attach DHR/IMA-81 and NOE forms when submitting on paper to: Claims Processing Division, Maryland Department of Health, P.O. Box 1935, Baltimore, Maryland 21203
b) Claims beyond 12 months of eligibility determination date: Route for paper submission with cover letter to: Institutional - Provider Resolution Unit, Maryland Department of Health, P.O. Box 22751, Baltimore, Maryland 21203
- Train staff that all retroactive eligibility claims MUST be submitted on paper (electronic submission is not permitted).
- Add requirement to attach DHR/IMA-81 or NOE documentation to all paper claims for retroactive eligibility.
- Consequence: Claims submitted electronically or without required documentation will not be processed.
3. For X02 and X03 Eligibility Groups (Undocumented/Unqualified Aliens):
- Staff submitting claims should contact patient's LDSS Case Manager for DHR/IMA-81 letters for X02 group.
- Staff should email mdh.mchppolicy@maryland.gov for DHR/IMA-81 letters for X03 group.
- Document contact procedures in billing system and staff reference guides.