Get Maryland Medical Assistance Program Billing ... - Mmcp Dhmh Maryland

Filling out the Maryland Medical Assistance Program Billing form is essential for providers wishing to submit claims for services rendered. This guide provides a step-by-step approach to ensure accuracy and compliance, making the process straightforward for all users.

Follow the steps to correctly complete the form.

1. Press the ‘Get Form’ button to acquire the form, which will allow you to access it for editing.
2. Begin filling out the required sections starting with the Billing Provider Name, Address, and Telephone Number. Ensure that the name matches what is filed with the Medical Assistance Program, providing a complete street address, city, state, and ZIP code.
3. In the Patient Control Number section, input the unique alphanumeric control number that the patient receives from the hospital.
4. In the Type of Bill section, enter the appropriate three-digit code indicating the type of bill being submitted, ensuring not to include any leading zeros.
5. Fill in the Statement Covers Period by providing 'From' and 'Through' dates in the specified format, noting that invoices cannot cover multiple months.
6. For the Patient's Name, use the name as it appears on the Medical Assistance card, ensuring correct order of last name, first name, and middle initial.
7. Proceed to enter the Patient's Birth Date and any optional patient address information, specifying country code if outside the USA.
8. Document the Admission/Start of Care Date, ensuring this date corresponds with the first month of billing.
9. Fill in the Admission Hour by selecting the appropriate code that correlates with the admission time.
10. Enter the Priority (Type) of Visit code to indicate the urgency of the patient's admission.
11. Continue filling out the form by following the detailed instructions provided for each respective field, ensuring all required data is accurately entered. Conclude by reviewing the entire document for completeness and clarity before submission.
12. Once all fields are properly filled, you may save changes, download, print, or share the form as necessary.

Complete your forms online with confidence by following this guide to ensure accurate submissions.