Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Maryland MedicaidMedicaid · Prior Auth · Managed Care Organizations · MD · PediatricsHigh impact

Removal of Prior Authorization Requirement for Special Pediatric Hospitals

Act
by Dec 31, 2025
Effective date
Jan 1, 2026
Identified
Sep 29, 2026

Summary

Effective January 1, 2026, Maryland Medicaid eliminates the prior authorization requirement for transfers to in-state Special Pediatric Hospitals. Instead, providers must submit concurrent level-of-care reviews to Telligen within 5 calendar days of the requested start date, with continued stay reviews submitted within 3 days of expiration. Out-of-state facilities continue to require prior authorization.

Get alerts when payers change rules like this one

We check Maryland Medicaid and other payers every day and email you when a change matches your specialty and state.

Get Maryland Medicaid alertsPolicy Monitoring is free. No card required.

What to do

by Dec 31, 2025 · 6 steps
01Billing team must update authorization submission processes for in-state Special Pediatric Hospitals.
02Stop submitting prior authorization requests to Telligen for in-state facilities and instead prepare to submit concurrent reviews within 5 calendar days of admission start date using Qualitrac system with 'concurrent' timing selected.
03For subsequent reviews, submit 'continued stay review' requests within 3 days of current level-of-care expiration.
04Train all billing and authorization staff on the new process.
05Continue current prior authorization procedures for all out-of-state Special Pediatric Hospital transfers.
06Register for Telligen's mandatory training session on January 13, 2026 at 2:00pm.
If missed: Failure to submit reviews with correct timing will result in cases being closed as 'outcome not rendered' and potential claim payment reductions or denial of full per diem rates.

Original notice

Removal of Prior Authorization Requirement for Special Pediatric Hospitals
health.maryland.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Maryland Medicaid changes →
New Review Process for Special Pediatric Hospitals, Effective October 7, 2026MediumEffective Oct 7, 2026 · Special Pediatric HospitalUpdated 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

Related policy hubs

Maryland Medicaid policiesMD policy changesPediatrics

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account