MedicaidAdministrativeHigh impact
Sunsetting of the Temporary Waiver of Requirements for Concurrent Reviews
Maryland Medicaid·MD·Provider Transmittal
Effective date
Aug 15, 2021
We identified it
Jun 20, 2026
Summary
Maryland's temporary waiver of concurrent review requirements for acute care hospitals, implemented during COVID-19, ends on August 15, 2021. Hospitals must resume submitting concurrent reviews within 48 hours of admission or by the next business day, or face technical claim denials. The peer-to-peer review process is also reinstated.
Action Required
By August 15, 2021: (1) Billing and utilization review teams must resume submitting all Fee-for-Service inpatient concurrent reviews to Telligen (Maryland's utilization control agent) within 48 hours of admission or by the next business day per COMAR 10.09.92.06B. (2) Update internal processes and workflows to enforce the 48-hour/next business day submission deadline. (3) Reinstate the peer-to-peer review process outlined in Hospital Transmittal No. 265. (4) Train billing and clinical staff on the reinstatement of these requirements. Failure to submit concurrent reviews within the required timeframe will result in technical claim denials. Contact Denise James at 410-767-1939 or denise.james@maryland.gov with questions.