Maryland law requires a participating Medicaid provider to accept payment from Medicaid as payment in full for a covered service. It is one of the conditions of being a Medicaid provider.
For a covered service, a Medicaid provider may not:
- Directly bill a participant or any family member.
- Balance bill – that is bill the patient the difference between the cost of the service and what Medicaid paid.
- Bill a participant for a denied covered service - for example, when the denial is due to an administrative error like a timely filing issue or failure to get prior authorization.
- Bill a participant for a missed or broken appointment.
- Bill a participant for failure to enroll rendering providers.
Reminder: You must use the Electronic Verification System (EVS) to verify a Medicaid participant's eligibility status before rendering services.
Failure to Comply
If you, or an employee, do not follow billing rules, the Maryland Department of Health may:
Ensure your staff is aware of the billing rules as their error could result in action against you.
Your patients may submit a complaint to the Maryland Attorney General's Health Education and Advocacy Unit (HEAU) if they believe they received an improper bill. To submit a complaint, visit the Maryland Attorney General's Health Education and Advocacy Unit (HEAU) web page.
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