Maryland Medicaid Prohibits Balance Billing
Maryland Medicaid Prohibits Balance Billing
UnitedHealthcare Community Plan is reminding providers that balance billing is not permitted for members enrolled in Maryland Medicaid programs or eligible dual plans.
To stay compliant with Maryland Department of Health rules, federal Medicaid requirements, and your UnitedHealthcare Community Plan Provider Agreement, providers should verify a member’s eligibility and benefits before services are provided.
What This Means for Providers
Providers may not bill Medicaid members for remaining balances when:
- The billed charge is higher than the UnitedHealthcare Community Plan fee schedule
- A claim is denied due to late submission
- A service was not authorized
- A service is denied as not medically necessary
- A claim is still under review by UnitedHealthcare Community Plan of Maryland
Balance billing members for covered services can lead to payment recoupment, sanctions, or termination from the Maryland Medicaid program.
What Providers Should Do
To support price transparency and avoid billing issues, providers should:
- Verify member eligibility before providing care
- Explain which services are covered and noncovered under Maryland Medicaid
- Inform members in advance if they may have any financial responsibility
- Keep health insurance details updated in all billing systems
- Collect only cost-sharing amounts allowed by Maryland Medicaid, when applicable
- Bill all other responsible third parties first, since Maryland Medicaid is the payer of last resort
If the member has other health coverage, that plan is usually the primary payer. When submitting a claim to UnitedHealthcare Community Plan, include the primary payer’s explanation of benefits or remittance advice when applicable.
How to Check Eligibility and Benefits
Providers can check member eligibility and benefits through the UnitedHealthcare Provider Portal.
Steps:
- Sign in with your One Healthcare ID
- Register for a One Healthcare ID if you do not have one
- Select Eligibility
- Enter the required search details
Providers can also review the eligibility and benefits training guide for more support.
Additional Information
For more details, providers can use the Understanding Balance Billing interactive guide. It explains member rights and includes guidance for participating providers, non-participating providers, and opted-out providers.
For questions, providers can connect with UnitedHealthcare through the 24/7 chat option in the Provider Portal.
