Help & FAQ's

Consumer/Recipient Eligibility

It is the provider’s responsibility to confirm consumer eligibility. Before rendering services, providers should request the recipient’s Medicaid identification card. See Maryland DHMH instructions for verifying eligibility using their Eligibility Verification System (EVS).

National Provider Identifier (NPI)

The National Provider Identifier (NPI) is a unique 10-digit numeric identifier for covered healthcare providers. The NPI must be used on all claims.

For all claims, whether submitted electronically or on paper, the provider’s billing and rendering NPI must be submitted. There are some exceptions to the rendering NPI requirement, based on provider type.

Outpatient Mental Health Clinics (OMHC), Federally Qualified Health Centers (FQHC) and Psychiatric Rehabilitation Providers (PRP) are not required to include the rendering provider’s NPI.

On all outpatient laboratory claims whether submitted electronically or on paper, the referring provider’s NPI must be included.

On all institutional claims whether submitted electronically or on paper, the attending provider’s NPI must be included.

Electronic Claims: see the HIPAA Implementation Guide for NPI placement. The HIPAA Implementation Guide can be purchased at http://www.wpc-edi.com/hipaa.