MedicaidAdministrativeHigh impact
Incorrect Billing of Participants with Medicaid
Maryland Medicaid·MD·Provider Transmittal
Effective date
Jun 25, 2015
We identified it
Jun 20, 2026
Summary
Maryland Medicaid providers are strictly prohibited from balance billing participants or charging participants for any covered services. Providers must accept Medicaid payment as payment in full and can only bill the Medicaid program or assigned MCO for covered services.
Action Required
Immediately: All billing staff must stop any balance billing practices for Maryland Medicaid patients. Update billing system to prevent charging participants for covered services. Ensure staff access Medicaid Eligibility Verification System (EVS) at 1-866-710-1447 or www.emdhealthchoice.org before billing. For MCO patients, verify coverage and obtain necessary preauthorizations before service. Violation of these requirements may result in sanctions including termination from the Medicaid program.