Pages - Credentialing, Contracting, and Fee Schedules

Credentialing, Contracting, and Fee Schedules

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Overview
The billing process starts with insurance enrollment and payer contracting. This section provides resources on those concepts along with fee schedule information, Prior Authorization, and insurance contract resources.

Document Title	Date Document Added	Source
General
NPPES FAQs	Oct 8, 2024	National Plan and Provider Enumeration System
Physician Assistants Modernization Act	Oct 2, 2024	Maryland Board of Physician's
https://www.medstarfamilychoice.com/new-provider-interest-form	Sep 27, 2024	MedStar Family Choice
Provider Panels: The Credentialing Process	Sep 25, 2024	Maryland Insurance Administration
Find Your Taxonomy Code	May 26, 2024	CMS
CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process	May 26, 2024	CMS
CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process	Feb 28, 2024	HHS
MLN Provider Enrollment Changes to the Medicare Program Integrity Manual - Effective 1/1/24	Dec 22, 2023	Medicare Learning Network
BCBS Credentialing Frequently Asked Questions \| FAQs \| CareFirst BlueCross BlueShield	Oct 27, 2023	BCBS
First-Time approval the goal for prior authorizations and claims	Oct 27, 2023	Medical Economics
Understanding the Role of the FTC, DOJ and States in Challenging Anticompetitive Practices of Hospital and Other Healthcare Providers	Aug 24, 2023	KFF
AHA, AMA, BCBSA Urge CMS Not to Adopt Proposed Standards for Healthcare Attachments	Aug 24, 2023	The HIPPA Journal
Prior authorization reduction equals nearly 20 percent of overall volume	Aug 24, 2023	United Healthcare
National Plan & Provider Enumeration System NPPES FAQs	Jul 31, 2023	NPPES
Congress dips back into the prior authorization fight	Jul 31, 2023	Axios
Spotlight Prior Authorization in Medicare Advantage	May 31, 2023	MGMA
JHHC Maryland Uniform Credentialing Form	Apr 15, 2023	JHHC
Kaiser Participating Providers Responsibilities	Apr 15, 2023	Kaiser
UnitedHealthcare Credentialing Plan updates	Mar 29, 2023	United Healthcare
2023 Medicaid Professional Services Fee Schedule	Feb 22, 2023	MDH MD Medicaid Administration
Fee Schedules
Maryland Medicaid Dental Fee Schedule and Procedure Codes CDT 2024	Oct 11, 2024	Maryland Medicaid
PBHS Fee Schedules	Feb 3, 2025	Carelon
Calendar Year (CY) 2025 Medicare Physician Fee Schedule Proposed Rule	Jul 27, 2024	CMS
Maryland Medicaid Fee schedule https://health.maryland.gov/mmcp/Documents/2024%20Professional%20Services%20Fee%20Schedule%20New%20Effective%201.1.24%20updated%205.15.2024.xls	Jun 25, 2024	Maryland Medicaid
Maryland Medicaid 2024 Medical Laboratory Fee Schedule- Effective April 1, 2024-updated 6-12-2024.pdf (maryland.gov)	Jun 25, 2024	Maryland Medicaid
Physician Fee Schedule	May 26, 2024	CMS
Medicaid Provider Program Resources and Fee Schedules	May 26, 2024	MDH
Adult Dental Pilot Program Overview	Apr 29, 2024	MDH
Medicare Physician Fee Schedule Final Rule Summary: CY 2024	Feb 28, 2024	Medicare Learning Network
Review of New Medicare Payment Policies Addressing Health-Related Social Needs Under the Calendar Year 2024 Physician Fee Schedule	Jan 28, 2024	Harvard Law School
hCY 2024 Medicare Physician Payment Schedule & Quality Payment Program (QPP) Final Rule Summary	Dec 22, 2023	AMA
https://www.novitas-solutions.com/webcenter/portal/MedicareJL/FeeLookup	Dec 22, 2023	Novitas
ABA Fee Schedule Eff 1.1.2024.pdf (optum.com)	Dec 22, 2023	Payer
PBHS SUD Fee Schedule Eff 1.1.2024.pdf (optum.com)	Dec 22, 2023	Payer
Health Home Fee Schedule Eff 1.1.2024.pdf (optum.com)	Dec22, 2023	Payer
Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule	Nov 20, 2023	CMS
Physicians take another gut punch with 3.4% cut to Medicare Physician Fee Schedule	Nov 20, 2023	Medical Economics
Proposed 2024 Medicare Physician Payment and Quality Reporting Changes	Oct 27, 2023	MGMA
Medicare 2023 Telehealth Fee Schedule	May 31, 2023	Medicare
COVID-19 Reimbursable Vaccine and Infusion Codes Fee Schedule	Feb 22, 2023	MDH MD Medicaid Administration
Monkeypox Vaccine and Vaccine Administration Fee Schedule	Feb 22, 2023	MDH
SUD FY 2022 MD Medicaid Fee Schedule	Feb 22, 2023	Administration
Medicaid
Maryland Medical Assistance Program Mental Health Services Transmittal No. 6	Aug 27, 2024	MDH
Behavioral Health Crisis Services	Aug 27, 2024	MDH
Community Based Substance Use Disorder Fee Schedule	Aug 27, 2024	MDH
ePREP Basics Presentation	Jul-2018
Getting Started, ePrep Sign Up Instructions	No date
Medicaid Credentialing ePREP	2021
PECOS
2024 Virtual National Provider Compliance Conference Aug 7-8 2024	Jun 25, 2024	CMS
Introducing PECOS 2.0	May 26, 2024	CMS
Instructions for Completing the EFT Authorization Agreement	Mar 30, 2024	CMS
Medicare Revalidation List	Feb 28, 2024	CMS
PECOS Provider Demographic Updates	Apr 15, 2023	CMS
CMS Introducing PECOS 2.0	Mar 29, 2023	CMS
PECOS FAQ’S (cms.gov)	Mar 29, 2023	CMS

CAQH
New and Updated CAQH CORE Operating Rules for Healthcare Payments and Claims Processing Efficiency	Oct 5, 2024	CAQH
CAQH Streamlining Claims Management	Apr 15, 2023	CAQH
CAQH ProView - Sign In	Feb 22, 2023	CAQH
NPI


Payer
Access new cultural competency trainings today UHC	Jul 27, 2024	United Healthcare
Prior Authorization and Notification	Mar 30, 2024	United Healthcare
Reminder: Balance billing is not permitted	Mar 30, 2024	United Healthcare
Regulatory Brief: 2024 Medicare Advantage Part D Proposed Rule: Prior Authorization	Aug 24, 2023	Medicare
ePrep Basics and Return to Provider Applications RTPs	Jul 31, 2023	MDH
Medicare Revalidation List	Jul 31, 2023	CMS
Getting Started with PECOS FAQs	Jul 31, 2023	CMS
Before You Start: A Checklist for a Provider or Supplier Organization Using PECOS	Jul 31, 2023	CMS
Carefirst BCBS Provider Credentialing Application	Jul 31, 2023	United Healthcare