MedicaidAdministrativeHigh impact
Timely Filing Requirements for Retroeligibility Submissions
Maryland Medicaid·MD·Provider Transmittal
Effective date
Jul 27, 2021
We identified it
Jun 20, 2026
Summary
Maryland Medical Assistance Program implemented new timely filing requirements for retroactive eligibility submissions. For claims submitted more than one year after discharge, providers must now include proof of eligibility determination date with retrospective review submissions to Telligen, and must submit the supporting documentation (DHR/IMA-81 or OES-401 form) within 20 calendar days or face technical denial. Claims within 12 months of eligibility determination can be billed electronically or on paper; claims beyond 12 months must be submitted on paper to the Provider Resolution Unit with a cover letter.
Action Required
Effective immediately: (1) Billing team must update retroactive eligibility claim submission procedures to ALWAYS require proof of eligibility determination date (DHR/IMA-81 or OES-401 form) when submitting retrospective reviews to Telligen for cases more than one year past discharge. (2) Establish 20-calendar-day deadline tracking system—if proof of eligibility is not submitted to Telligen within 20 days of request, claims will receive technical denial. (3) For claims within 12 months of eligibility determination: may submit electronically or on paper to Claims Processing Division, P.O. Box 1935, Baltimore, MD 21203. (4) For claims BEYOND 12 months of eligibility determination: MUST submit on paper with cover letter to Institutional - Provider Resolution Unit, P.O. Box 22751, Baltimore, MD 21203—electronic submission is prohibited. (5) Update billing software to flag retroactive eligibility claims and enforce paper submission rules based on time limits. (6) Train all billing and revenue cycle staff on new submission pathways and 20-day documentation deadline. Failure to comply will result in technical denials and payment denials. This transmittal supersedes Hospital Transmittal No. 255.