Maryland has the most unusual billing environment in the country. Hospitals bill every payer at rates set by the state’s Health Services Cost Review Commission, while professional claims run through a conventional market led by CareFirst and a wide field of HealthChoice Medicaid plans. Summit Billing Solutions bills for Maryland practices with both systems in view.
We provide end-to-end Medical billing services
tailored to the needs of Maryland healthcare providers, including:
Our goal is to help practices across Maryland get paid faster while reducing billing-related stress and operational inefficiencies.
Maryland's many HealthChoice MCOs and its dominant commercial carrier each run their own edits. We work denials plan by plan and push the fixes upstream into scheduling and coding.
HealthChoice spreads Maryland Medicaid across a wide field of MCOs, and ePREP governs enrollment for all of them. An out-of-date ePREP record stops payment quietly and completely.
MCO adjudication speeds differ, and coordination with Maryland's rate-regulated hospital billing adds steps other states never see. We track each payer's clock and follow up on schedule.
ePREP enrollment, MCO credentialing and CareFirst panels each cycle separately. We manage all three calendars so nothing lapses and nothing stops paying.
We support billing for Maryland Medicaid through its HealthChoice managed care organizations, including Priority Partners, Maryland Physicians Care, CareFirst Community Health Plan, Aetna Better Health and UnitedHealthcare. Provider enrollment and revalidation run through the ePREP portal, and each MCO applies its own authorization and filing rules on top.
CareFirst BlueCross BlueShield anchors the commercial market, with UnitedHealthcare, Aetna and Cigna also active. Maryland’s all-payer hospital rate setting shapes how facility and professional components split on many claims, and billing that ignores the split leaves money misallocated.
