MedicaidDocumentationHigh impact
Maryland Medicaid: Reminder of state medical records audit
UnitedHealthcare·MD·State news
Effective date
Aug 1, 2026
We identified it
Jul 2, 2026
Summary
Maryland Medicaid is conducting annual encounter data validation audits from August through November 2026, comparing medical records against claims submissions. Billing providers must ensure documentation is complete, accurate, and properly aligned with billed procedure, diagnosis, and revenue codes to avoid audit findings, claim denials, or payment recoupments.
Action Required
By July 31, 2026: Billing team must conduct comprehensive audit readiness review. (1) Verify all medical records are complete, legible, and organized in paper or electronic format; ensure all services rendered are documented. (2) Audit all active claims to confirm diagnosis codes, procedure codes, and revenue codes match supporting documentation exactly. (3) Review claim amounts to verify they correspond to services actually provided. (4) Establish protocol to respond to Maryland Department of Health audit letters within 48 hours when urgent records are requested. (5) Designate staff to receive phone/fax contact from Qlarant (the state auditor) and establish expedited record retrieval process. (6) Train providers and clinical staff on documentation requirements using the Maryland Provider Care Manual. Failure to submit accurate, aligned records will result in audit findings, claim denials, and mandatory payment recoupments.