MedicaidAdministrativeHigh impact
Enrolling Referring Maryland Medicaid Providers
Maryland Medicaid·MD · Pediatrics, Physical Therapy, Occupational Therapy +1 more·Provider Transmittal
Effective date
Jun 1, 2021
We identified it
Jun 20, 2026
Summary
Effective June 1, 2021, Maryland Medicaid Fee-for-Service requires all referring providers for early intervention and school health services to be enrolled with Maryland Medicaid, and their NPI number must be included on all related claims. Claims submitted without an enrolled referring provider's NPI will be denied regardless of date of service.
Action Required
By May 31, 2021: Identify all referring providers who submit claims for early intervention and school health services related to IEP or IFSP cases in Maryland. Verify each referring provider's active Medicaid enrollment status using the Provider Verification System (PVS) at https://encrypt.emdhealthchoice.org/searchableProv/main.action. Any referring providers not currently enrolled must complete enrollment as PT 91 provider type immediately at eprep.health.maryland.gov to avoid claim denials. Billing team must update internal provider database and claims submission processes to require and validate the enrolled referring provider's NPI on all early intervention and school health service claims submitted on or after June 1, 2021. Failure to include the enrolled referring provider's NPI will result in automatic claim denial. Contact Stanlee Lipkin at 410-767-1599 or Stanlee.Lipkin@maryland.gov with enrollment questions.