MedicaidPrior AuthMedium impact
Emergency Room Services
Maryland Medicaid·MD · Emergency Medicine·Provider Transmittal
Effective date
Aug 3, 1998
We identified it
Jun 20, 2026
Summary
Maryland Medicaid clarifies that hospitals should NOT call MCOs for preauthorization before providing emergency room services that meet the prudent layperson standard. MCOs are required to reimburse emergency services without prior authorization and cannot deny payment based on later diagnostic findings.
Action Required
Immediately: Emergency department staff should stop calling MCOs for preauthorization before providing emergency services that meet prudent layperson criteria. Provide emergency services first, then bill MCOs afterward. Update ED protocols to reflect that preauthorization is not required for emergency services meeting the specified criteria.