MedicaidPrior AuthMedium impact
Instructions for the DHMH Preauthorization Form (DHMH 4527)
Maryland Medicaid·MD·Medical Supply and Equipment
Effective date
Feb 9, 2001
We identified it
Jun 20, 2026
Summary
Maryland Medicaid has issued instructions for completing the DHMH 4527 Preauthorization Request Form for durable medical equipment, disposable medical supplies, and oxygen/respiratory equipment. This provides step-by-step guidance for proper form completion to facilitate timely processing of preauthorization requests.
Action Required
Immediately: Maryland providers must review and implement the DHMH 4527 form completion instructions. Use separate forms for each category (DME, disposable supplies, oxygen equipment). Ensure all sections are complete including recipient eligibility verification, provider enrollment status, physician signatures/orders, medical justification, and accurate item identification. Mail completed forms to Office of Operations and Eligibility, Division of Claims Processing, P.O. Box 17058, Baltimore, MD 21203. Incomplete forms will be denied causing delays in patient care.