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  • Maryland Medical Care Program Submitter Identification Form - Dhmh - Dhmh Maryland

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MARYLAND MEDICAL CARE PROGRAMS SUBMITTER IDENTIFICATION FORM For Version 005010 HIPAA Transaction Set Maryland Medicaid needs some EDI information to exchange HIPAA transactions with you. Please provide.

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Maryland-specific balance billing protections If you are in a health maintenance organization (HMO) governed by Maryland law, you may not be balance billed for services covered by your plan, including ground ambulance services.

Provider Enrollment: 1-844-463-7768. Recipient Enrollment: 1-855-642-8572. EVS – Eligibility Verification: 1-866-710-1447. Optum (toll-free, follow prompts): 1-800-888-1965, TTY 711.

You must submit a clean claim to the Maryland Medical Assistance Program within 12 months of the date of service (for acute hospitals—date of discharge). A clean claim is an original, correctly completed claim that is ready to process. Submit claims immediately after providing services.

Log on to your account at MarylandHealthConnection.gov or call 1-855-642-8572. If you do not have an account at MHC, contact the agency where you applied for Medicaid. You are the only one who can use this card.

As long as you have the capability to send EDI claims to Change Healthcare through direct submission or through another clearinghouse/vendor, you may submit claims electronically using Payer ID# RP063.

Medicaid, also called Medical Assistance (MA) pays the medical bills of needy and low-income individuals.

The only documentation that will be accepted is a remittance advice, Medicare/Third-party EOB, IMA-81 (letter of retro-eligibility) and/or a returned date stamped claim from the Program. Paper Claims Submission: Once a claim has been received, it may take 30 business days to process your claim.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232