MedicaidAdministrativeMedium impact
Updated Dispute Resolution Process
Maryland Medicaid·MD · Psychiatry·Behavioral Health Administration Services Organization
Effective date
Oct 1, 2026
We identified it
Sep 5, 2026
Summary
Maryland's Dispute Resolution Committee (DRC) process for behavioral health claims is shifting from postal mail to electronic submission only, effective October 1, 2026. All DRC submissions must now go to mdh.mcoasodisputeresolution@maryland.gov via secure email. The policy also clarifies eligibility requirements: only claims denied by both the BHASO and MCO, after first-level appeals with both payers, and with no prior payment except EMTALA triage fees, can be submitted to the DRC.
Action Required
REQUIREMENTS:
— By October 1, 2026: Billing team must establish secure email submission capability to mdh.mcoasodisputeresolution@maryland.gov and retire postal mail submission processes for all DRC cases. Remove P.O. box address from billing procedures and templates.
— Immediately (before October 1, 2026): Billing team should begin submitting all DRC cases electronically to become familiar with the process; postal submissions will be rejected after the effective date.
— Update internal workflows and staff training to ensure: (1) DRC cases are submitted ONLY after both BHASO (Carelon Behavioral Health) and participant's MCO complete first-level appeals; (2) Appeal determination letters from both payers are attached to all DRC submissions; (3) The updated MCO/BHASO Dispute Resolution Committee Review Form is used with complete documentation; (4) Claims meet all four eligibility criteria (dual denials, dual first-level appeals completed, no partial payment except EMTALA triage fee, dates of service within one year of submission).
— Update billing software workflows to flag incomplete DRC submissions—the Committee will not review cases with incomplete forms or missing documents.
— Consequence of inaction: Postmarked mail submissions after October 1, 2026 will not be accepted; incomplete electronic submissions will be rejected without review.