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New Review Process for Special Pediatric Hospitals, Effective October 7, 2026
Effective date
Oct 7, 2026
Identified
Sep 26, 2026
Summary
Effective October 7, 2026, the Maryland Medical Assistance Program's new review process for special pediatric hospitals supersedes PT 99-26 for fee-for-service prior authorization, continued stay review and retrospective review. The process sets submission timing in Telligen's Qualitrac system for prior authorization, concurrent requests, continued stay reviews and retrospective reviews. Requests submitted more than 1 business day late are technically denied, and administrative day requests are tied to approved reviews.
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What to do
Action · 8 steps
01Already effective October 7, 2026: Special pediatric hospitals submit prior authorization requests in Telligen's Qualitrac system before the requested start date, selecting 'prospective' for timing.
02Without prior authorization, submit the concurrent request on day 15 of admission (or the next business day) for dates of service days 1 through 14, selecting 'concurrent', and submit continued stay reviews every 14 days for the previous 14 dates of service until discharge, regardless of previous outcomes.
03For levels of care expiring on or after October 6, 2026, submit the next CSR 15 calendar days after the existing LOC expires (or the next business day).
04A concurrent or continued stay review submitted more than 1 business day late is technically denied, and dates of service on review requests technically denied for missing documentation or late submission are not eligible for administrative days.
05Submit retrospective reviews on day 91 and every 90 days thereafter until discharge, selecting 'retrospective review', 'Acute/Med Surg' and 'Special Pediatric', and upload the full medical record.
06Submissions covering less than 90 days, other than the final review after discharge, are closed as 'outcome not rendered'.
07An issued decision is required for every date of service before billing can proceed.
08A first level appeal of a retrospective review denial must be requested within 30 calendar days.
Original notice
New Review Process for Special Pediatric Hospitals, Effective October 7, 2026
health.maryland.gov · Always check the source before changing claims.
Related changes
See all Maryland Medicaid changes →Removal of Prior Authorization Requirement for Special Pediatric HospitalsHighEffective Jan 1, 2026 · Managed Care OrganizationsUpdated Prior Authorization Process for Special Pediatric HospitalsHighEffective Jul 1, 2026 · Managed Care OrganizationsPT 48-26: Removal of Prior Authorization Requirement for Special Pediatric HospitalsMediumEffective Jan 1, 2026 · Prior AuthorizationBrowse every Maryland Medicaid change in the policy list