MedicaidReimbursementMedium impact
Reimbursement for Professional Services Provided to Medical Assistance Recipients Who are Admitted to a Hospital Prior to Enrollment in an MCO
Maryland Medicaid·MD·Provider Transmittal
Effective date
Dec 3, 1998
We identified it
Jun 20, 2026
Summary
MCOs are now required to reimburse providers for professional services provided to Medical Assistance recipients who were admitted to the hospital before enrolling in the MCO. Previously, MCOs were not paying these professional fees, leading to provider complaints and unpaid claims.
Action Required
Billing team should resubmit any previously denied professional service claims for Medical Assistance recipients who were admitted to hospital prior to MCO enrollment. Verify MCO enrollment dates against hospital admission dates for all Medical Assistance claims. Follow up on outstanding claims that may have been denied due to this issue.