Medical Billing Services in Maryland
Billing, coding, credentialing and denial management for Maryland practices, with Medicare claims through Novitas Solutions (Jurisdiction JL) and Maryland Medicaid handled by people who know the rules.
Medical billing for Maryland practices
Maryland practices bill a payer mix shaped by a few large names. CareFirst BlueCross BlueShield carries much of the commercial market, Novitas Solutions processes Medicare Part B under Jurisdiction L, and nine HealthChoice managed care organizations handle most Medicaid claims. A practice in Baltimore or Silver Spring can see patients from all of them in a single week, each with its own prior authorization lists, claim edits and fee schedules.
SFA Solutions works with Maryland practices remotely. We submit most clean claims within 24 hours, keep your Maryland Medicaid enrollment current so the MCOs can load you, and work denials from CareFirst, the HealthChoice plans and Medicare. Maryland's 30-day prompt pay rule also gives us a clear clock for chasing late commercial payments.
Maryland at a glance
| Medicare contractor | Novitas Solutions, Jurisdiction JL |
|---|---|
| Medicaid timely filing | 12 months from the date of service (or discharge, depending on provider type) for fee-for-service claims; HealthChoice MCOs set their own limits by contract |
| NP practice authority | Full |
| Cities we serve | Baltimore, Columbia, Germantown, Silver Spring, Frederick, Rockville, Gaithersburg, Bethesda, Annapolis, Hagerstown |
What Maryland billing involves
These are the programs and rules our team works with for Maryland claims.
Medicare
Novitas Solutions · JLMaryland Part B claims are processed by Novitas Solutions in Jurisdiction JL. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Maryland Medicaid
Maryland Medicaid (Maryland Medical Assistance Program), with most enrollees in HealthChoice managed care; Maryland Children's Health Program (MCHP) for eligible children
Portal: ePREP for provider enrollment and revalidation; eMedicaid for single claim entry and eligibility checks; Maryland Medicaid Electronic Exchange for EDI claim files, all run by the Maryland Department of Health
Medicaid managed care
HealthChoice members are served by nine MCOs: Aetna Better Health of Maryland, CareFirst BlueCross BlueShield Community Health Plan Maryland, Jai Medical Systems, Kaiser Permanente, Maryland Physicians Care, MedStar Family Choice, Priority Partners, UnitedHealthcare Community Plan and Wellpoint Maryland. Specialty behavioral health is carved out and billed through the state's Public Behavioral Health System administrator.
Timely filing
12 months from the date of service (or discharge, depending on provider type) for fee-for-service claims; HealthChoice MCOs set their own limits by contract.
Commercial and Medicare Advantage
CareFirst BlueCross BlueShield is the largest commercial carrier, followed by UnitedHealthcare, Aetna, Cigna and Kaiser Permanente of the Mid-Atlantic States. UnitedHealthcare, Aetna and Humana hold large Medicare Advantage enrollment.
Prompt pay law
Under Maryland Insurance Article 15-1005, carriers must pay a clean claim within 30 days of receipt, and late payments on clean claims accrue interest.
Nurse practitioners
Full practiceMaryland NPs can evaluate, diagnose and prescribe without a physician collaboration agreement, which the state repealed in 2015. Applicants for initial NP certification name an experienced NP or physician to serve as a mentor for 18 months. NPs enroll with Medicare, Maryland Medicaid and commercial plans under their own NPI, and Medicare pays 85% of the physician fee schedule when services are billed under the NP.
Credentialing
Maryland Medicaid enrollment and revalidation run through ePREP, and HealthChoice MCOs generally need an active Maryland Medicaid number before they will add you to their network. CareFirst, UnitedHealthcare and Aetna pull credentialing data from CAQH ProView, so keep your profile attested every 120 days to avoid stalled applications.
Billing challenges Maryland practices face
Nine MCOs, nine rulebooks
Each HealthChoice MCO publishes its own prior authorization list, timely filing limit and claim edits. A service that clears with Priority Partners can still pend with Maryland Physicians Care or Wellpoint. We track rules by plan and verify the patient's MCO before each visit so the claim goes to the right payer.
Behavioral health carve-out
Specialty mental health and substance use services for Medicaid patients are carved out of HealthChoice and billed through the state's Public Behavioral Health System administrator. Sending those claims to the MCO produces denials that burn filing time. We route each service line to the correct payer at charge entry.
Holding carriers to the 30-day clock
Maryland law requires clean claims to be paid within 30 days, with interest owed on late payments. Many practices never check. We age commercial claims against that clock and follow up as soon as a carrier misses it.
Our services in Maryland
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Maryland
Maryland medical billing questions
What is the timely filing limit for Maryland Medicaid?
Fee-for-service Maryland Medicaid claims must be received within 12 months of the date of service or discharge, depending on provider type. A corrected claim for a timely claim that was rejected must also be filed within 12 months of that date. HealthChoice MCOs set their own deadlines, so check each plan's provider manual.
Who is the Medicare contractor for Maryland?
Novitas Solutions is the A/B Medicare Administrative Contractor for Maryland under Jurisdiction L (JL). Enrollment changes go through PECOS, and Novitas handles Part B claims, redeterminations and its Novitasphere portal for claim status.
How fast must Maryland insurers pay clean claims?
Maryland Insurance Article 15-1005 requires carriers to pay clean claims within 30 days of receipt, and late payments carry interest. The rule applies to state regulated plans. Self-funded employer plans fall under federal ERISA rules instead.
Can SFA Solutions bill for my Maryland practice remotely?
Yes. We work inside your existing EHR or practice management system remotely and handle charge entry, claim submission, denials and A/R follow-up for Maryland practices. We can typically begin within 24 hours of receiving system access.
Get a free billing audit for your Maryland practice
We will review your recent claims and denials against Maryland payer rules and show you what can be recovered.
Nearby states
Primary sources
- Maryland Insurance Administration: Prompt Pay and Clean Claims
- Maryland Medicaid: Fee-for-Service Claims
- HealthChoice MCO Comparison Chart
- Maryland General Assembly: HB 999 (2015), Nurse Practitioners
- CMS: Who Are the MACs
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
Request your free practice audit
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