MedStats Billing delivers end-to-end revenue cycle management built for Maryland practices. We hold carriers to the 30-day clean claim rule in Insurance § 15-1005, pursue interest that escalates to 2.5% per month the longer a claim sits, bill hospital and hospital-based services against HSCRC-approved rates, and work all nine HealthChoice MCOs alongside the 45-day workers’ compensation payment rule.
Maryland is the only state in the country that sets hospital rates for every payer through a single commission, and it is the only state on this list whose prompt-pay interest gets more expensive the longer a payer waits. Unpaid clean claims escalate from 1.5% a month to 2.5% a month, and the interest must be added to the late payment without the provider asking for it. Work injury bills run on a 45-day payment rule with a 12-month submission limit and a three-year rescue window at the Commission. Maryland pays practices that read the calendar and the rate order.
Maryland Billing Specializations:
Prompt Payment of Claims (Ins. § 15-1005) — A carrier, nonprofit health service plan or HMO must pay a clean claim within 30 days of receipt, and must pay the undisputed portion of a claim inside the same 30 days. Where the carrier requests additional information, it has 30 days from receiving it to pay or deny.
Escalating Statutory Interest — Interest on the unpaid amount runs at 1.5% per month from day 31 through day 60, 2% per month from day 61 through day 120, and 2.5% per month after day 120. It must be included in the late reimbursement without the provider filing anything for it, which is exactly why nobody checks that it arrived.
The 180-Day Submission Floor — Plans subject to the statute must allow providers at least 180 days from the date of service to submit a claim, so a contract clause shorter than that does not bind. We hold payers to the statutory floor.
Maryland Insurance Administration Enforcement — Prompt-pay failures are enforced through MIA complaints rather than private suit, and a documented pattern carries administrative consequences for the carrier. We build the claim-level record those complaints need.
HSCRC All-Payer Hospital Rates — Hospital services are billed at rates approved by the Health Services Cost Review Commission and apply to every payer under Maryland’s Total Cost of Care Model. Hospital and hospital-based billing follows the rate order, not a negotiated fee schedule, while professional services do not.
HealthChoice Managed Care — Maryland Medicaid runs through nine HealthChoice MCOs: Aetna Better Health of Maryland, CareFirst Community Health Plan Maryland, Jai Medical Systems, Kaiser Permanente, Maryland Physicians Care, MedStar Family Choice, Priority Partners, UnitedHealthcare Community Plan and Wellpoint Maryland. Each carries its own authorization and submission rules.
Workers’ Compensation Payment Rule (COMAR 14.09.08) — An employer or insurer must reimburse the provider, or deny in full or in part, within 45 days of receiving the CMS-1500. Overdue balances carry a statutory penalty and interest, and the Commission’s Medical Fee Guide prices services from Medicare relative values with Commission conversion factors.
Workers’ Compensation Filing Limits — Bills are due within 12 months, and where that window is missed the provider must file an application for payment with the Commission on Form C-51 inside three years to preserve the claim. We track both.
Personal Injury Protection Verification — Maryland PIP is limited and waivable, so auto injury patients may carry $2,500 of coverage, a higher elected limit, or none at all. Coverage is confirmed before treatment continues rather than after the balance ages.
Major Maryland Payers — CareFirst BlueCross BlueShield, Johns Hopkins Health Plans, Kaiser Permanente, Aetna, Cigna, UnitedHealthcare and the nine HealthChoice MCOs.
Built to bring clarity, control and consistency to your Maryland practice’s revenue cycle.
MedStats Billing manages the complete revenue cycle for Maryland providers — from eMedicaid enrollment and HealthChoice MCO credentialing, through coding, claim scrubbing and submission, to denial resolution, escalating interest recovery, MIA complaints and workers’ compensation claims for medical services before the Commission.
Certified CPT, ICD-10-CM, and HCPCS coding with pre-submission claim scrubbing built around each payer's edits, so claims pay on the first pass. We manage charge entry, claim submission, payment posting, and insurance follow-up.
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Enrollment with Medicaid managed care plans, Medicare via PECOS, and commercial payers — plus CAQH maintenance and re-credentialing deadline tracking, so your providers stay in-network and billable without gaps.
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Coverage confirmed before the visit — active policy status, deductibles, co-pays, plan type, and prior authorization requirements — so front-end denials are caught while there is still time to fix them.
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Aged claims worked by payer and denial reason, with appeals filed inside each plan's window. We monitor outstanding balances, manage rejections, and drive down days in A/R to protect cash flow.
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A detailed review of coding accuracy, documentation standards, and denial patterns that identifies revenue leakage and compliance exposure — before a payer audit finds it for you.
Explore serviceLocal SEO, Google Business Profile optimization, and reputation management built for medical practices — helping the patients already searching for your specialty find you first.
Explore serviceMaryland practices lose more revenue to interest nobody audits and deadlines nobody tracks than to coding, and the statute is unusually punitive toward slow payers. These are the four we eliminate:
Interest runs at 1.5% per month from day 31, 2% from day 61 and 2.5% after day 120, and must be included in the late payment without the provider claiming it. Because it is automatic, practices assume it was paid. On a claim that sat for four months that assumption is expensive.
Plans subject to the prompt-pay statute must allow providers at least 180 days from the date of service to submit a claim. Practices that work to a shorter limit written into a payer contract or a portal message write off claims the statute still requires the payer to accept.
Maryland hospital services are priced by the Health Services Cost Review Commission and apply to every payer, so a hospital or hospital-based claim follows the approved rate order rather than a payer-negotiated amount. Practices that mix the two produce underpayments they cannot appeal and overpayments that get recouped.
Work injury bills are due within 12 months, and once that window closes the employer or insurer is not required to pay unless the provider files an application for payment with the Commission on Form C-51 within three years. Most practices never file the C-51, and the balance simply disappears.
A carrier, nonprofit health service plan or HMO must pay a clean claim within 30 days of receipt and must pay the undisputed portion of a claim inside the same window. Interest on the unpaid amount runs at 1.5% per month from day 31 through day 60, 2% per month from day 61 through day 120 and 2.5% per month after day 120, and must be added to the late reimbursement without a separate claim for it.
Maryland is the only state that sets hospital rates for all payers. Hospital and hospital-based services are billed at rates approved by the Health Services Cost Review Commission under the state’s Total Cost of Care Model, which removes payer-by-payer negotiation from those claims and makes the rate order the reference for both appeals and audits.
An employer or insurer must reimburse the provider, or deny in full or in part, within 45 days of receiving the CMS-1500, with a statutory penalty and interest on overdue balances. Bills are due within 12 months of service, and after that the provider must file an application for payment with the Commission on Form C-51 within three years. The Medical Fee Guide prices services from Medicare relative values with Commission conversion factors.
Maryland Medicaid runs through nine HealthChoice MCOs: Aetna Better Health of Maryland, CareFirst Community Health Plan Maryland, Jai Medical Systems, Kaiser Permanente, Maryland Physicians Care, MedStar Family Choice, Priority Partners, UnitedHealthcare Community Plan and Wellpoint Maryland. Each has its own authorization rules, submission channel and denial patterns, and eligibility is verified per visit.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursementsto maximizes your revenue potential.
MedStats Billing handles eMedicaid enrollment, HealthChoice MCO credentialing, 30-day clock tracking, escalating interest recovery, HSCRC-aligned hospital billing and workers’ compensation claims across Maryland, giving practices end-to-end RCM support in the most distinctively regulated market in the country.
Claims are scrubbed against HealthChoice MCO and commercial carrier edits before submission to drive clean first-pass reimbursement.
Hospital and hospital-based services are priced against the applicable HSCRC-approved rates rather than a negotiated schedule, so underpayments are visible and appealable.
We track the 30-day clock on every clean claim and pursue the escalating 1.5%, 2% and 2.5% monthly interest Maryland attaches to late payment, rather than assuming the carrier included it.
Working knowledge of CareFirst BlueCross BlueShield, Johns Hopkins Health Plans, Kaiser Permanente, Aetna, Cigna, UnitedHealthcare and all nine HealthChoice MCOs.
Whether you practise in Baltimore, Silver Spring, Rockville, Annapolis or Salisbury, our workflows adjust seamlessly as your group grows across the state.
HIPAA-compliant data handling and controlled access protect patient health information and billing records at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Schedule a complimentary billing assessment with MedStats Billing to uncover hidden revenue loss, check whether the escalating interest Maryland owes you was ever paid, and confirm your hospital-based claims were priced against the correct approved rates.
Under Insurance § 15-1005 an insurer, nonprofit health service plan or HMO must pay a clean claim within 30 days of receipt, and must pay the undisputed portion of a claim within the same 30 days. Where the carrier asks for additional information, it must pay or deny within 30 days of receiving it. Prompt-pay failures are enforced through the Maryland Insurance Administration.
Interest accrues on the amount of the claim that remains unpaid 30 days after receipt, at 1.5% per month from day 31 through day 60, 2% per month from day 61 through day 120, and 2.5% per month after day 120. It must be included in any late reimbursement without the provider making an additional claim for it, so the correct question is not whether it is owed but whether it was actually paid.
Plans subject to the prompt-pay statute must allow providers at least 180 days from the date of service to submit claims. A shorter limit asserted in a payer contract or a portal notice does not override that floor for plans the statute covers, so claims inside 180 days should not be written off as untimely.
Maryland is the only state that sets hospital rates for every payer. Under the Total Cost of Care Model, hospital rates are approved by the Health Services Cost Review Commission and apply across commercial, Medicare and Medicaid alike, so hospital and hospital-based claims are priced from the rate order rather than a negotiated fee schedule. Professional services billed outside that structure are not rate-regulated, which is where mixed billing errors arise.
Under COMAR 14.09.08 the employer or insurer must reimburse the provider, or deny the bill in full or in part, within 45 days of receiving the CMS-1500. Overdue balances carry a statutory penalty and interest. Where a bill is denied, the provider can pursue payment through a claim for medical services and, if necessary, a hearing before the Workers’ Compensation Commission.
Nine managed care organizations serve HealthChoice: Aetna Better Health of Maryland, CareFirst Community Health Plan Maryland, Jai Medical Systems, Kaiser Permanente, Maryland Physicians Care, MedStar Family Choice, Priority Partners, UnitedHealthcare Community Plan and Wellpoint Maryland. Plan availability and network depth vary by jurisdiction, so eligibility and plan assignment are verified before each visit.
We serve practices and healthcare facilities statewide, including Baltimore, Columbia, Germantown, Silver Spring, Waldorf, Frederick, Rockville, Gaithersburg, Bowie, Towson, Bethesda, Annapolis, Hagerstown and Salisbury.
