Maryland Medicaid Therapy Claims and Telehealth
By Dax Earl • October 9, 2026
Last updated: October 9, 2026.
For Maryland Public Behavioral Health System (PBHS) claims, start with Carelon’s Provider Digital Front Door.
As of October 9, 2026, Carelon directs Maryland Medicaid behavioral health providers to the Maryland Public Behavioral Health System payer space in Availity Essentials for claims. Its registration instructions distinguish Availity from ProviderConnect access. Read Carelon’s Join the Network instructions.
Sections
Set up Availity and ProviderConnect for different tasks
Carelon’s instructions have providers register with ProviderConnect and Availity, then establish single sign-on in Availity. ProviderConnect supports authorization work; Availity supports direct entry and batch claims. The same page describes individual accounts, Super Users and a group Account Request Form. Multi-factor authentication is required and account credentials cannot be shared. Follow the current account setup instructions.
Recommended biller handoff: verify that the user can access the correct practice and the Maryland PBHS payer space before submitting. Track claim submission access separately from authorization access. A successful sign-in is only the beginning of that check.
Check the service route and claim instructions
Review Carelon PBHS vs HealthChoice before choosing a claim destination
Carelon’s Manuals and Billing Guides page links the PBHS manual, denial-code resources and billing instructions. Use these for the service and provider type rather than copying a payer ID or coding rule from an older claim. Open the official billing guides.
Recommended pre-submission review: confirm the billing and rendering provider records, the service date, the member’s coverage, the applicable authorization and the intended claim route. After submission, retain the transaction evidence and review the returned claim status before deciding the next action.
Maryland Medicaid telehealth: check GT, UB and POS
Maryland’s May 15, 2025 synchronous telehealth guide, linked from its current telehealth page, specifies GT for audiovisual telehealth and UB for covered audio-only services. Audio-only coverage is program-specific. The guide also retains service restrictions, authorization requirements and consent documentation. Read the state telehealth policy guide.
For Medicaid-only fee-for-service claims, that guide says to use the place of service appropriate to a non-telehealth claim based on the rendering practitioner’s location, and not POS 02 or 10. For Medicare crossover claims, it says to use the Medicare claim’s POS, with 02 and 10 permitted. These are distinct instructions; do not apply a generic commercial telehealth template to both. See Coding Telehealth Visits on page 3.
Maryland’s telehealth hub says provider-specific regulations and manuals establish which services may be delivered through telehealth. Check the current service guidance and licensing-board requirements before using a modality or code. Open the current telehealth resources.
For a service routed to a HealthChoice MCO, check that plan’s current claim instructions as well. The state FFS examples above are not a substitute for resolving the actual service route.
Use a telehealth review checklist before releasing claims
Recommended worksheet for your biller:
Identify the actual service, provider type and responsible program.
Record whether the encounter was audiovisual or audio-only, and confirm that modality is covered for the service.
Use the applicable guide to confirm the procedure code, modifier and POS together.
Verify the service-date eligibility and any required authorization.
Confirm required consent and clinical documentation in the practice’s approved record.
Keep any unresolved coding or enrollment issue attached to the claim task until it is resolved.
When MPRIME enrollment is still pending
The transition’s temporary courtesy-authorization process is not a payment guarantee. The August 21 MDH memo tells affected providers to hold claims until they are enrolled through MPRIME and meet the backdating conditions. An authorization or portal account does not remove that hold. Review the temporary transition memo.
Read the existing enrollment-hold guide for conditions and deadlines
Frequently Asked Questions
Do I submit Maryland PBHS claims through MPRIME?
Carelon directs Maryland Medicaid behavioral health claims to the Maryland PBHS payer space in Availity. MPRIME is the state provider enrollment system.
What telehealth modifiers does Maryland’s guide specify?
The May 15, 2025 guide specifies GT for audiovisual and UB for covered audio-only services. Check current service-specific guidance and coverage before billing.
Should every Maryland Medicaid telehealth claim use POS 02 or 10?
No. The state guide distinguishes Medicaid-only fee-for-service claims from Medicare crossover claims. Follow the applicable route’s instructions rather than a universal telehealth POS rule.
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