Medical Billing Services in Maryland.
Maryland operates one of the nation’s most sophisticated Medicaid managed care programs—HealthChoice—alongside a uniquely regulated all-payer hospital system that affects how providers are reimbursed by every payer, including Medicare and commercial insurers. Happy Billing supports Maryland providers with deep expertise in HealthChoice managed care billing, HSCRC rate compliance, and the complex credentialing requirements of Maryland’s leading health systems: Johns Hopkins Medicine, University of Maryland Medical System, and MedStar Health.
Maryland Medicaid (HealthChoice) Billing
Maryland Medicaid covers approximately 1.5 million residents—nearly one in four Marylanders. Total Medicaid/CHIP enrollment stood at nearly 1.7 million in mid-2024 after the unwinding process, representing an 88% increase since late 2013. Maryland’s unwinding was among the most efficient in the nation: net enrollment declined only 6.4% versus a 13.9% national average, and 74% of renewals were completed automatically via ex parte redetermination. The program added full adult dental benefits in 2023—a significant billing opportunity for dental providers.
HealthChoice Managed Care Program
Maryland has used Medicaid managed care since 1991. As of 2022, approximately 90% of Medicaid members are enrolled in HealthChoice managed care organizations (MCOs), while 10% remain in fee-for-service (primarily dual-eligible Medicare-Medicaid enrollees and long-term care residents). Maryland contracts with any willing provider that meets state requirements, setting rates through actuarial analysis. External quality review is performed by the Delmarva Foundation. There are currently nine MCOs in the HealthChoice program: Aetna Better Health, CareFirst BlueCross BlueShield Community Health Plan Maryland, Community Health Plan Maryland, Jai Medical Systems, Kaiser Permanente, Maryland Physicians Care, MedStar Family Choice, Priority Partners, and UnitedHealthcare.
Key Maryland Medicaid Billing Requirements
- MCOs set their own fee schedules within Maryland Department of Health (MDH) rate floors; providers must contract with each MCO separately
- Adult dental benefits added effective January 2023—new billing codes and coverage pathways for dental providers
- Maryland’s all-payer hospital rate system (HSCRC) regulates hospital inpatient and outpatient rates for all payers including Medicare and Medicaid
- Behavioral health services are largely carved out into a separate managed care structure
- HEDIS and CAHPS performance measures required; external QRO review by Delmarva Foundation
- MDH administers fee-for-service for dual eligibles and long-term care populations outside MCO enrollment
- Potential work requirements for Medicaid expansion adults starting January 2027 under federal legislation
Major Maryland Health Systems: Billing Landscape
Maryland’s hospital market is dominated by large nonprofit academic systems concentrated in the Baltimore–Washington corridor. The state’s HSCRC all-payer rate regulation creates unique billing complexity—hospital rates are set uniformly across payers, reducing the variability seen in other states but requiring careful compliance with HSCRC methodologies.
Johns Hopkins Medicine
Johns Hopkins Medicine is the flagship academic health system in Maryland and one of the most recognized medical institutions in the world. Anchored by Johns Hopkins Hospital in Baltimore—consistently ranked #1 nationally by U.S. News & World Report—the system includes six hospitals and over 40 primary and specialty care sites. Providers seeking Johns Hopkins network participation must navigate rigorous credentialing standards and Epic-based workflows across the system. HealthChoice members enrolled in Priority Partners (a Johns Hopkins-affiliated MCO) access Hopkins facilities as their primary network.
University of Maryland Medical System (UMMS)
UMMS is a private nonprofit system headquartered in Baltimore with 11 hospitals statewide, 4 freestanding emergency rooms, and 150+ care locations. UMMS has more than 2,400 licensed beds, 100,000 annual admissions, and gross patient revenues of approximately $4.86 billion. UMMS medical staff work in partnership with the University of Maryland School of Medicine. The system’s flagship University of Maryland Medical Center in Baltimore is a Level I trauma center and major academic referral hub. UMMS partners with CareFirst BlueCross BlueShield Community Health Plan Maryland for HealthChoice managed care.
MedStar Health
MedStar Health is headquartered in Columbia, Maryland and operates the largest healthcare network in the mid-Atlantic region with annual revenue of $8.3 billion. The system includes Georgetown University Hospital in Washington, D.C., and multiple Maryland facilities including MedStar Franklin Square, Harbor Hospital, Good Samaritan, Union Memorial, and Southern Maryland Hospital. MedStar Family Choice is a HealthChoice MCO affiliated with MedStar, serving Medicaid enrollees in the Baltimore metro area and across the state.
Specialties We Serve in Maryland
Each specialty page dives into the specific billing challenges and our approach. Visit our Specialties to explore the one most relevant to your practice.
Why Maryland Providers Choose Happy Billing
- Comprehensive HealthChoice MCO credentialing across all nine Maryland plans
- HSCRC all-payer rate compliance expertise for hospital-based providers
- Adult dental benefit billing for Maryland Medicaid (effective 2023)
- Priority Partners, MedStar Family Choice, and UMMS/CareFirst network expertise
- Ex parte renewal monitoring and redetermination support for Medicaid populations
- Baltimore and Washington metro market knowledge with statewide rural coverage
Maryland Medical Billing FAQs
What is the HealthChoice all-payer rate system in Maryland?
Maryland’s Health Services Cost Review Commission (HSCRC) sets hospital inpatient and outpatient rates that apply to all payers—Medicare, Medicaid, and commercial insurers—uniformly. This global budget model is unique in the country and means hospital providers must comply with HSCRC methodology rather than negotiating individual payer rates.