Maryland Medicaid Provider Enrollment
Why Maryland Medicaid Provider Enrollment is One of the most Complex in the USA
Maryland’s Medicaid program officially called Medical Assistance operates through one of the most sophisticated managed care structures in the United States. Unlike states that run a straightforward single-enrollment system, Maryland providers face a multi-layered enrollment challenge, state-level enrollment through the ePREP portal, separate credentialing with up to nine HealthChoice MCOs, mandatory ORP (Ordering, Referring, and Prescribing) enrollment for all prescribers, and a behavioral health carve-out requiring additional registration with Carelon Behavioral Health. If you miss any one of these tracks, and your claims are denied by insurance company.
With approximately 1.5 million Marylanders enrolled in Medicaid and the Maryland Children’s Health Program (MCHP), and roughly 85% of those members enrolled in HealthChoice MCOs, the stakes are enormous. Maryland’s Medicaid program is not just a payer, it’s an entire ecosystem of managed care plans, behavioral health contractors, and federal compliance requirements. This guide breaks down every layer so you can enroll correctly, credential efficiently, and start billing without costly delays.
One more critical planning item, Maryland Medicaid is transitioning from ePREP to a brand-new portal called MPRIME in October 2026. A phased hold on ePREP applications will precede the launch. If your enrollment, revalidation, or updates aren’t completed before that hold begins, you may face an enrollment gap that directly impacts your revenue.
What is Maryland Medicaid? You Need to Understand the Medical Assistance Program and HealthChoice
Maryland Medicaid, formally the Medical Assistance Program, is administered by the Maryland Department of Health (MDH) through the Office of Health Care Financing. It provides health coverage to qualifying low-income residents, including children, pregnant women, adults, the elderly, and people with disabilities.
The defining feature of Maryland Medicaid is HealthChoice, the state’s mandatory managed care program operating since 1997. With few exceptions, all Medicaid beneficiaries under age 65 must enroll in one of nine HealthChoice MCOs. If a beneficiary does not choose an MCO, they are auto-assigned to one with available capacity in their county. Members can change MCOs within 90 days of enrollment, or once every 12 months thereafter.
Key Facts About Maryland Medicaid / Medical Assistance
| Data Point | Fact |
|---|---|
| Program Name | Maryland Medical Assistance (Medicaid) |
| Administering Agency | Maryland Department of Health (MDH) — Office of Health Care Financing |
| Managed Care Program | HealthChoice — Maryland's Medicaid Managed Care Program (since 1997) |
| Current Enrollment (2026) | ~1.5 million Marylanders (Medicaid + MCHP combined) |
| MCO Enrollment Rate | ~85% of Medicaid population enrolled in HealthChoice MCOs |
| Number of Active MCOs | 9 MCOs serving HealthChoice members statewide |
| Enrollment Portal (Current) | ePREP — Electronic Provider Revalidation and Enrollment Portal (eprep.health.maryland.gov) |
| Portal Transition (Upcoming) | MPRIME — Maryland Provider Registration and Information Management Enterprise — launching October 2026 |
| ORP/Prescriber Enrollment | Mandatory for all Ordering, Referring, and Prescribing providers under ACA Section 6401 |
| Revalidation Cycle | Every 5 years for most providers |
| Behavioral Health Contractor | Carelon Behavioral Health of Maryland (separate ID required for BH providers) |
| Uniform Credentialing Form | MCOs must use Maryland Uniform Credentialing Form for all network providers |
Key Insight: With ~85% of Maryland Medicaid beneficiaries in HealthChoice MCOs, state-level ePREP enrollment alone does not give you full billing access. You must also credential separately with each MCO. This dual-track requirement is Maryland’s most significant enrollment complexity.
IMPORTANT: MPRIME Transition, Maryland Medicaid is replacing ePREP with the MPRIME portal in October 2026. A phased hold on ePREP applications will take effect before launch, freezing new enrollments, revalidations, and updates. Complete all pending enrollment actions before the hold begins.
Maryland's Three-Track Enrollment System: State, MCO, and Behavioral Health
Maryland’s enrollment complexity comes from its three separate but interconnected tracks. Missing any one of them creates billing gaps.
State Enrollment via ePREP (Maryland MDH)
- Required for ALL providers billing Maryland Medicaid
- Completed through ePREP at eprep.health.maryland.gov
- Issues your Maryland Medical Assistance (MA) Provider Number
- Requires signing the Provider Agreement electronically in ePREP
- Certain provider types must also complete and upload a provider-type-specific addendum
MCO Credentialing (HealthChoice)
- Required separately with each of the 9 HealthChoice MCOs whose members you serve
- Each MCO uses the Maryland Uniform Credentialing Form
- MCO credentialing does NOT happen automatically after state enrollment
- Each MCO has its own portal, timelines (60–120 days), and requirements
- Credentialing can take up to 120 days from the date an MCO starts the process
Behavioral Health — Carelon Registration
- Required for behavioral health providers (mental health clinics, drug clinics, SUD residential, etc.)
- After MDH enrollment approval, Carelon emails/mails your Carelon ID
- You must register at maryland.carelonbh.com to activate behavioral health billing
- Without Carelon registration, BH claims are denied even if state enrollment is complete
Full Provider Enrollment vs. ORP Enrollment: Which One Do You Need?
Maryland offers two distinct enrollment pathways. Understanding which one applies to each provider in your organization before you begin is critical, and many practices need both.
| Factor | Full Provider Enrollment | ORP Enrollment (Ordering/Referring/Prescribing) |
|---|---|---|
| Purpose | Bill Maryland Medicaid directly for services rendered | Order, refer, or prescribe for Medicaid members without billing |
| Signs Provider Agreement? | Yes, required at enrollment and revalidation | No, ORP providers do not sign Provider Agreement |
| Can Submit Claims? | Yes | No — cannot bill or receive payment from Maryland Medicaid |
| Can Appear as Rendering Provider? | Yes | No — cannot appear on a claim as rendering provider |
| Documentation Required | Comprehensive (license, NPI, insurance, disclosures, addenda) | Reduced — license or residency program certificate |
| Cost | Free | Free |
| Portal | ePREP (eprep.health.maryland.gov) | ePREP (eprep.health.maryland.gov) |
| Revalidation Required | Yes — every 5 years | Yes — every 5 years |
| Best For | Physicians, NPs, hospitals, DME, labs billing Medicaid | Psychiatrists with private-pay patients; residents; prescribers only |
Who Needs to Enroll? Maryland Medicaid Provider Eligibility Overview
Healthcare providers who plan to treat Maryland Medicaid beneficiaries and receive reimbursement must complete the state’s provider enrollment process. Eligible providers include physicians, hospitals, behavioral health professionals, therapists, laboratories, DME suppliers, and many other approved healthcare organizations.
Individual Provider Requirements
| Requirement | Details |
|---|---|
| Active State License | Current, unrestricted Maryland license for your specialty |
| NPI Type 1 (Individual) | Registered in NPPES with correct taxonomy code, must match application exactly |
| DEA Certificate | Required for controlled substance prescribers; upload certificate copy |
| Federal Employer ID / SSN | Required for identity verification in ePREP |
| Malpractice Insurance | Active coverage documentation |
| CAQH Profile | Used for cross-verification with MCO credentialing; must be current |
| ePREP Account | Create account at eprep.health.maryland.gov before starting application |
| Provider Agreement | Must be signed electronically in ePREP at enrollment and revalidation |
| Practice-Type Addendum | Required for certain provider types — uploaded via ePREP Applications tab |
| OIG/SAM Exclusion Check | Must not appear on any federal exclusion list |
| NABP Number | Required for pharmacy providers |
| Specialty Code | Two-digit code designating type of practice; primary specialty must be designated |
Group / Organizational Provider Requirements
- NPI Type 2 (organizational NPI registered in NPPES)
- Federal Employer Identification Number (EIN) and IRS W-9
- Articles of Incorporation or proof of legal business entity
- Ownership and control disclosure forms
- Provider roster with individual NPIs for all associated practitioners
- Facility malpractice / general liability insurance certificates
- Accreditation documentation (CLIA, Joint Commission, CARF, JCAHO as applicable)
- Provider-type-specific addendum (required for certain facility types)
- ADA accessibility status for physical locations
Provider Types Eligible for Maryland Medical Assistance Enrollment
- Physicians (MD, DO) and Osteopathic Practitioners
- Nurse Practitioners (NPs) and Certified Nurse Midwives
- Physician Assistants (PAs)
- Mental Health Clinicians (Psychiatrists, Psychologists, LCSWs, LPCs)
- Physical, Occupational, and Speech-Language Therapists
- Home Health Agencies and Personal Care Providers
- Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
- Hospitals (general acute care, specialty, critical access)
- Outpatient Mental Health Clinics (OMHCs) and Drug Clinics
- Substance Use Disorder (SUD) Residential Facilities
- DME Suppliers and Home Infusion Providers
- Pharmacies and Pharmacy Providers
- Clinical Laboratories and Diagnostic Radiology
- Dentists and Dental Clinics
- Podiatrists, Optometrists, and Allied Health Professionals
Maryland HealthChoice — Active MCO Plans
| MCO Name | Type | Key Notes |
|---|---|---|
| Aetna Better Health of Maryland | National, for-profit | 7-step provider enrollment process; quarterly credentialing reports required |
| Priority Partners (Johns Hopkins) | Local, non-profit | Enrollment sanction lifted Feb 2026 after NCQA reaccreditation |
| Maryland Physicians Care | Local, provider-owned | Serves 200,000+ members; 20+ years in HealthChoice |
| UnitedHealthcare Community Plan | National, for-profit | One of the larger national plans in Maryland |
| Amerigroup (Wellpoint/Elevance) | National, for-profit | Also known as Wellpoint Maryland |
| Jai Medical Systems | Local | Community-focused MCO |
| CareFirst BlueCross BlueShield | Local, non-profit | Large regional health plan |
| Kaiser Permanente Mid-Atlantic | Integrated HMO | Region-specific; serves select counties |
| MedStar Family Choice | Local, non-profit | Hospital system-affiliated MCO |
Step-by-Step: Maryland Medicaid Provider Enrollment Process
Create Your ePREP Account
You need to visit eprep.health.maryland.gov and create your ePREP account. You will receive an activation email in your inbox; click the activation link to complete your account setup. This step is required before any application can begin.
When logging in for the first time, select: ‘My Applications’ → ‘I’m new to Maryland Medicaid and I want to create a new application’ → choose your provider type (Individual or Facility/Organization).
Identify and Download Your Provider-Type Addendum
Before completing the main application, visit health.maryland.gov/mmcp/provider/Pages/eprepforms.aspx and download the addendum specific to your provider type. Not all providers need an addendum, but those who do must complete it and upload it in the correct location within ePREP (Applications tab → Additional Information → Practice Information). Using the wrong addendum or uploading it to the wrong section is one of the leading causes of application rejection.
Gather All Required Documentation
Do not begin your ePREP application without all documents ready. Incomplete submissions cause processing holds that restart the review clock.
- Current, unrestricted Maryland state license for your specialty
- NPI Type 1 — verify exact name matches your IRS/legal name character-for-character
- DEA certificate (if applicable — verify dates are current)
- Federal Employer ID Number or SSN
- Malpractice insurance certificate (active coverage dates)
- CAQH profile (current and attested, needed for MCO credentialing)
- Completed provider-type addendum (if required)
- OIG/SAM exclusion clearance for all owners and providers
- NABP number (pharmacy providers)
- Specialty code (two-digit practice type code)
Complete the ePREP Application
The ePREP application collects:
- Provider identification: NPI, taxonomy code, provider type, specialty code
- Practice location details: address, hours, phone, fax, ADA status
- License, certification, and DEA information (with document uploads)
- Federal Employer ID or SSN for identity verification
- Ownership and control disclosures
- OIG/SAM exclusion attestation
- Group NPI affiliations (if applicable)
- Electronic signature on the Maryland Medical Assistance Provider Agreement
Upload Addendum and Supporting Documents
Navigate to the Applications tab → Additional Information → Practice Information within ePREP. Upload your completed addendum here along with any additional documents requested in the addendum itself. Upload order and location matter, files uploaded to the wrong section may not be processed with your application.
ORP Enrollment for Prescribing Providers
If any provider in your organization orders, refers, or prescribes for Maryland Medicaid members but does not bill Maryland Medicaid directly, enroll them as ORP through ePREP. Select the ORP provider option in the application type selection. ORP enrollment requires a license or residency program certificate (for residents without a full license). ORP providers are verified through the Medicaid Provider Verification System (PVS).
Submit and Monitor Your Application
After submission, your application enters MDH’s review queue. Monitor your application status in ePREP and respond to any development requests promptly. Contact the Provider Enrollment Helpline if you have not received any update within 30 business days.
Provider Enrollment Helpline: 1-844-4MD-PROV (1-844-463-7768) Monday–Friday, 9 AM–5 PM. For ePREP tutorials and step-by-step guides, visit health.maryland.gov/mmcp/provider/Pages/eprepresources.aspx
Receive MA Provider Number and Activate Billing
Once approved, you will receive your Maryland Medical Assistance Provider Number. Activate your EFT/EDI billing setup and verify your NPI is linked correctly before submitting any claims.
Register with Carelon (Behavioral Health Providers Only)
After MDH approval, behavioral health providers receive a Carelon ID at their address on file. Register at maryland.carelonbh.com immediately upon receipt. Without this step, your behavioral health claims will be denied.
Begin MCO Credentialing (Start This in Parallel with Step 4)
Contact each HealthChoice MCO you wish to join and begin their credentialing process using the Maryland Uniform Credentialing Form. MCO credentialing is completely separate from state enrollment and has its own timelines (60–120 days per MCO). Starting both tracks simultaneously minimizes total time to billing.
Maryland Medicaid Enrollment Timeline: What to Realistically Expect
The Maryland Medicaid enrollment timeline typically ranges from 30 to 90 days for a complete application, although complex ownership structures, missing documentation, site visits, or background screenings can extend the processing time of your application. You need to submit a clean, accurate application through the state’s enrollment portal, and responding promptly to requests for additional information helps minimize delays and speeds up approval.
| Stage | Typical Timeline | Key Notes |
|---|---|---|
| ePREP account creation | 1 business day | Required before any application; activation email sent |
| Document preparation & addendum download | 1–2 weeks | Use provider-type-specific addendum from MDH website |
| ePREP application completion | 1–3 business days | Complete all sections; upload supporting documents |
| MDH initial review | 15–30 business days | May request additional documentation (development requests) |
| Risk-based screening | 2–6 weeks | Varies by provider risk category (Limited/Moderate/High) |
| Site visits (if required) | Varies | Moderate and High risk provider types |
| Fingerprinting (if required) | 1–2 weeks | High-risk provider types |
| Final approval & MA Provider Number issued | 2–4 weeks post-screening | |
| MCO credentialing (parallel track) | 60–120 days each MCO | Must credential separately with each HealthChoice MCO |
| EFT/EDI billing activation | 1–2 weeks post-approval | Required before submitting first claim |
| TOTAL — State enrollment (clean app) | 45–90 days | Add MCO credentialing time for full billing access |
| TOTAL — Including all MCO credentialing | 90–180 days | Start state enrollment and MCO credentialing simultaneously |
Most Common Reasons Maryland Medicaid Applications Get Delayed or Denied
Maryland Medicaid provider applications are often delayed due to incomplete documentation, missing ownership disclosures, expired licenses, enrollment data mismatches, or credentialing errors. It is your team responsibility to review all requirements before submission; it helps you to reduce processing delays, avoid denials, and accelerate approval.
| Issue | Frequency | Impact | How to Prevent It |
|---|---|---|---|
| Missing or wrong provider-type addendum | Very High | Application rejected | Download correct addendum from health.maryland.gov/mmcp/provider |
| NPI/name mismatch with NPPES or IRS records | Very High | Manual review; delays | Verify character-for-character match before submitting |
| Provider Agreement not signed in ePREP | High | Application incomplete | Sign electronically within ePREP — do not mail separately |
| ORP provider not enrolled (prescribers) | High | Pharmacy claim denials | Enroll all ordering/referring/prescribers as ORP via ePREP |
| Missing or expired malpractice certificate | High | Application hold | Check expiration dates before submission; upload current cert |
| Addendum not uploaded to correct ePREP location | High | Processing delay | Upload to Applications tab > Additional Information > Practice Information |
| Carelon BH ID not obtained (BH providers) | High | BH claim denials | Register with Carelon after MDH approval; enroll at maryland.carelonbh.com |
| Failure to credential with individual MCOs | Very High | Cannot bill MCO members | Start MCO credentialing simultaneously with state enrollment |
| Slow response to MDH development requests | Very High | Indefinite delay | Respond within 5 business days of any request |
| Revalidation missed or delayed | Medium | Claim denials; deactivation | Track revalidation date; complete before deadline |
| MPRIME transition confusion (Oct 2026) | Emerging | Enrollment gaps | Complete all enrollments before phased ePREP hold begins |
MDH Insight: Maryland Department of Health publishes specific 'Revalidation Tips' and guidance on frequently missed information. These documents are updated regularly and are essential reading before any application or revalidation submission.
Maryland Medicaid Provider Revalidation and What You Must Know
All Maryland Medicaid enrolled providers must revalidate every 5 years. Revalidation is conducted in ePREP (or MPRIME after October 2026) and requires re-signing the Provider Agreement and updating all enrollment information. Missing your revalidation deadline means claim denials and deactivation of billing privileges.
Key Revalidation Facts
- Revalidation cycle: Every 5 years for most provider types
- All providers must re-sign the Maryland Medical Assistance Provider Agreement at revalidation
- Revalidation is completed entirely in ePREP, no paper submissions accepted
- Risk-based screening is re-applied at revalidation (including possible site visits and fingerprinting for high-risk types)
- MDH notifies providers of revalidation due dates — but providers must track their own timelines
- ePREP Revalidation Tips document (available on MDH website) lists the most common revalidation errors
CRITICAL: After October 2026, revalidations will be processed through MPRIME, not ePREP. If your revalidation falls during the transition period, monitor MDH communications closely for guidance on which system to use and whether a hold applies to your revalidation.
Risk-Based Screening and What It Means for Your Maryland Medicaid Application
All Maryland Medicaid enrollment applications and their initial enrollments, maintenance cases, and revalidations are subject to federal risk-based screening requirements under the Affordable Care Act (42 CFR 455 Subpart E). Your provider type determines your risk category.
| Risk Level | Provider Types | Screening Applied |
|---|---|---|
| Limited | Physicians, NPs, hospitals, FQHCs, RHCs, clinics | License verification, OIG/SAM check, database screening |
| Moderate | Home health agencies, physical therapists, outpatient labs, rehabilitation facilities | All Limited checks + possible site visits |
| High | DME suppliers, personal care agencies, home infusion, substance use disorder facilities | All Moderate checks + fingerprinting, unannounced site visits |
Maryland Medicaid vs. Other Major Payers: Enrollment Complexity Comparison
Compared with Medicare and most commercial insurers, Maryland Medicaid enrollment is generally more complex due to its detailed screening requirements, ownership disclosures, and state-specific compliance through the ePREP enrollment portal.
| Factor | Maryland (Medical Assistance) | Maine (MaineCare) | Louisiana (Healthy LA) | TRICARE East |
|---|---|---|---|---|
| Delivery Model | Managed Care (HealthChoice MCOs) | Fee-for-Service | Managed Care (6 MCOs) | Regional contractor |
| MCO Credentialing Required? | Yes — separately per MCO | No (FFS only) | Yes — separately per MCO | N/A |
| Enrollment Portal | ePREP → MPRIME (Oct 2026) | MIHMS / Health PAS | lamedicaid.com | CAQH-based |
| ORP/NOPR Requirement | Yes (ORP — via ePREP) | Yes (NOPR — via MIHMS) | N/A | N/A |
| BH Carve-Out | Yes (Carelon BH) | No | No | N/A |
| Timeline (state only) | 45–90 days | 60–120 days | 90–120 days | 60–90 days |
| Total Timeline (incl. MCO) | 90–180 days | 60–120 days | 90–180 days | 60–90 days |
| Revalidation Cycle | Every 5 years | Every 5 yrs (DME: 3) | Every 5 yrs (DME: 3) | As required |
| Complexity Level | Very High | High | High | High |
Post-Enrollment Compliance: How to Stay Enrolled and Billing
Maryland Medicaid enrollment is an ongoing responsibility of healthcare professionals of the USA. These are the compliance obligations every enrolled provider must maintain in the USA.
License renewals: As a provider, you need to upload renewed license to ePREP immediately upon renewal; failure to maintain active license results in deactivation of your services.
Malpractice coverage: Your need to maintain continuous coverage; update ePREP on each renewal.
Address and contact changes: It is your responsibility to submit updates through ePREP promptly; do not let your address become outdated (revalidation notices are mailed to the address on file).
Ownership changes: Notify MDH within 30 days of any change in ownership or control structure.
CAQH attestation: Keep your CAQH profile current for MCO credentialing verification.
OIG/SAM checks: Run exclusion checks on all owners and clinical staff at hire and quarterly.
Carelon registration: You need to maintain an active Carelon account and update as needed (BH providers).
MCO re-credentialing: Each MCO requires re-credentialing on its own schedule (typically every 3 years).
Revalidation: Complete every 5 years before MDH due date; sign Provider Agreement in ePREP.
MPRIME transition: Monitor MDH communications for the ePREP phased hold timeline before October 2026.
Why Healthcare Providers Choose Our Credentialing Services for Maryland Medicaid
Maryland’s enrollment complexity, three parallel tracks, nine MCOs, a behavioral health carve-out, and a portal transition on the horizon make in-house enrollment management one of the most resource-intensive administrative tasks a practice can take on. Here’s what the comparison actually looks like:
In-House vs Our Credentialing Services
| Factor | In-House / DIY | Our Credentialing Services |
|---|---|---|
| State enrollment timeline | 3–6 months (with errors) | 45–90 days (optimized) |
| MCO credentialing coordination | Often siloed / delayed | Parallel-tracked from day one |
| Provider-type addendum selection | Frequently wrong or missed | Correctly identified and completed |
| ORP enrollment for prescribers | Often overlooked | Proactively completed |
| BH Carelon ID registration | Often missed post-approval | Completed immediately after MDH approval |
| ePREP → MPRIME transition prep | Uncertain / reactive | Proactive planning for October 2026 |
| MDH development request response | Varies / often slow | Within 24–48 hours |
| MCO uniform credentialing form | Inconsistently applied | Correctly applied per MCO standards |
| Revalidation management | Manual / easily missed | Automated tracking and alerts |
| Staff time per provider | 15–25 hours | Zero from your team |
| Claims denial risk | Higher | Significantly reduced |
Best Practices: How to Succeed with Maryland Medicaid Provider Enrollment
Before You Submit
- Create your ePREP account at eprep.health.maryland.gov before gathering any documents.
- Download and review the Enrollment Frequently Missed Information from the MDH website.
- Identify your provider-type addendum at health.maryland.gov/mmcp/provider/Pages/eprepforms.aspx
- Verify your legal name, NPI, and tax ID match exactly between NPPES, IRS records, and your application.
- Attest your CAQH profile within 90 days before applying (essential for MCO credentialing).
- Run OIG/SAM exclusion checks on all owners and practitioners.
- Confirm all licenses are active and not expiring within 60 days.
During the Application
- You need to complete your application all sections; leave no required fields blank
- Sign the Provider Agreement electronically within ePREP, do not attempt to mail it
- Upload your addendum to the correct location: Applications → Additional Information → Practice Information
- Submit EFT banking information with your application
- Respond to MDH development requests within 5 business days
- Start MCO credentialing on the same day you submit your state application
After Approval
- You need to verify your MA Provider Number and NPI linkage before billing
- Register with Carelon Behavioral Health immediately if applicable (maryland.carelonbh.com)
- Confirm your EFT payments are routing correctly
- Track your 5-year revalidation due date from the date of enrollment
- Complete your MCO credentialing for all relevant HealthChoice plans
- Monitor your MDH communications for MPRIME transition timelines and phased ePREP hold dates
Key Official Resources for Maryland Medicaid Provider Enrollment
You need to rely on official Maryland Medicaid resources to access the provider enrollment application, eligibility requirements, policy updates, and billing guidance. These below mentioned trusted sources help you complete enrollment accurately, remain compliant with state regulations, and avoid unnecessary processing delays.
| Resource | URL / Contact |
|---|---|
| Maryland Medicaid Provider Enrollment (ePREP) | eprep.health.maryland.gov |
| MDH Provider Enrollment Info Page | health.maryland.gov/mmcp/provider/Pages/enrollment.aspx |
| ePREP Instructions & Training | health.maryland.gov/mmcp/provider/Pages/eprepresources.aspx |
| ePREP Provider Addenda | health.maryland.gov/mmcp/provider/Pages/eprepforms.aspx |
| MPRIME Portal Transition Info | health.maryland.gov/mmcp/provider/Pages/mprime.aspx |
| ORP Enrollment Info | health.maryland.gov/mmcp/provider/Pages/opr.aspx |
| Provider Enrollment Helpline | 1-844-4MD-PROV (1-844-463-7768) Mon–Fri, 9 AM–5 PM |
| HealthChoice MCO Info (for members) | health.maryland.gov/mmcp/healthchoice |
| HealthChoice Helpline (for members) | 1-800-284-4510 |
| Carelon Behavioral Health Maryland | maryland.carelonbh.com | 1-800-888-1965 |
| Maryland Medicaid DataPort | hilltopinstitute.org/public-dataport |
| CMS Provider Enrollment (Federal) | cms.gov/Medicare/Provider-Enrollment-and-Certification |
| NPPES NPI Registry | nppes.cms.hhs.gov |
| CAQH ProView | proview.caqh.org |
| OIG Exclusion Database | oig.hhs.gov/exclusions |
| SAM.gov Federal Exclusions | sam.gov |
Frequently Asked Questions About Maryland Medicaid Provider Enrollment
What portal do I use to enroll as a Maryland Medicaid provider, and is there a transition coming?
Currently, all Maryland Medicaid provider enrollment, revalidation, information updates, and provider affiliations are managed through ePREP, the Electronic Provider Revalidation and Enrollment Portal at eprep.health.maryland.gov. However, Maryland Medicaid will be transitioning to a new system called MPRIME (Maryland Provider Registration and Information Management Enterprise) in October 2026. As part of this transition, MDH will implement a phased hold on ePREP applications before the go-live date. As a provider should complete any pending enrollment, revalidation, or updates well before October 2026 to avoid gaps.
What is an ORP provider and do I need that enrollment?
ORP stands for Ordering, Referring, and Prescribing provider. Under ACA Section 6401 and 42 CFR §455.410(b), all providers who order, refer, or prescribe for Maryland Medicaid members must be enrolled with Maryland Medicaid, either as a fully participating billing provider or as an ORP. ORP enrollment is for providers who prescribe or refer for Medicaid patients but do not bill Medicaid directly. ORP providers do not sign the Provider Agreement, cannot submit claims, and cannot appear as a rendering provider. This is required for residents, psychiatrists with private-pay arrangements, and any other prescriber not seeking direct Medicaid payment. The Medicaid Provider Verification System (PVS) allows billing providers (e.g., labs, DME) to verify that the ordering provider is actively enrolled before rendering the service.
What is the Carelon Behavioral Health requirement, and who does it apply to?
Carelon Behavioral Health of Maryland manages behavioral health services for Maryland Medicaid. Providers who enroll in certain behavioral health provider types (outpatient mental health clinics, drug clinics, residential SUD facilities, and others) must register with Carelon after receiving their Maryland Medicaid enrollment approval. After MDH approves your enrollment, Carelon will email, fax, or mail your Carelon ID to the address on file. You then register at maryland.carelonbh.com. Without completing this step, behavioral health claims will be denied even if you are fully enrolled with MDH. Contact Carelon at 1-800-888-1965 for assistance.
How long does Maryland Medicaid provider enrollment take?
State enrollment through ePREP typically takes 45–90 days for a clean, complete application. However, the total time until you can bill for most HealthChoice patients, including MCO credentialing, is 90–180 days. MCO credentialing alone can take 60–120 days per plan, and you must credential with each MCO separately. Starting state enrollment and MCO credentialing simultaneously is essential to minimizing your total time-to-billing.
What are the most common reasons your Maryland Medicaid enrollment applications are delayed?
Based on MDH guidance and published revalidation tips, the most common causes are:
(1) selecting or uploading the wrong provider-type addendum
(2) Your NPI or name mismatches between NPPES, IRS records, and the application,
(3) Not signing the Provider Agreement electronically in ePREP
(4) prescribers not enrolling as ORP
(5) uploading documents to the wrong ePREP section
(6) behavioral health providers failing to register with Carelon after MDH approval
(7) not responding promptly to MDH development requests for additional information.
What happens if I miss my 5-year revalidation with Maryland Medicaid?
Failure to revalidate results in claim denials and deactivation of your Maryland Medicaid billing privileges. All providers must sign the Provider Agreement in ePREP at both initial enrollment and revalidation. MDH notifies providers of their revalidation due date, but it is your responsibility to track and complete revalidation on time. If deactivated, you must re-enroll from scratch. Reactivation does not include retroactive payment for claims denied during the deactivation period.