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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



​
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, 2023Payer
​
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 ScheduleFeb 22, 2023 MDH
SUD FY 2022 MD Medicaid Fee ScheduleFeb 22, 2023 Administration
​Medicaid

​Maryland Medical Assistance Program Mental Health Services Transmittal No. 6​​

​Aug 27, 2024
​MDH

​



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 ePREP2021
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
​
​​



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

​​​