Credentialing in Maryland

Maryland carves specialty behavioral health OUT of its HealthChoice MCO package: physical health runs through the 9 HealthChoice MCOs under an 1115 waiver, while specialty BH is paid fee-for-service by one statewide ASO (COMAR 10.67.08.02). The ASO is Carelon Behavioral Health, effective January 1, 2025, replacing Optum Maryland. Do not cite Optum as Maryland's current ASO.

Carelon Maryland PBHS Provider Manual v3 via kb/states/md.md · checked Jul 2026

Maryland's 9 HealthChoice MCOs (physical health; BH is carved out to Carelon): Aetna Better Health of Maryland, Wellpoint Maryland (formerly Amerigroup), CareFirst BCBS Community Health Plan Maryland, Jai Medical Systems, Kaiser Permanente (closed-model, limited external participation), Maryland Physicians Care, MedStar Family Choice, Priority Partners, and UnitedHealthcare Community Plan of Maryland. Molina is NOT a Maryland HealthChoice MCO.

Carelon Maryland PBHS Provider Manual + MDH HealthChoice roster via kb/states/md.md · checked Jul 2026

Maryland Medicaid provider enrollment runs through ePREP (electronic Provider Revalidation and Enrollment Portal), screen first, always: providers may not render services until enrolled, and are at financial risk for services delivered before their MA number is active. Behavioral health enrollment is two steps: enroll in Medicaid via ePREP, then register with the ASO's Carelon Provider Digital Front Door for authorizations and claims. Revalidation also runs in ePREP on the 5-year federal floor.

Carelon Maryland PBHS Provider Manual v3 via kb/states/md.md · checked Jul 2026

Maryland's prompt-credentialing statute (Insurance § 15-112) binds commercial carriers only: within 30 days of receiving a completed application the carrier must send written notice of intent to continue or a rejection, and if it continues it has 120 days from that notice to accept or reject the provider. Critically, § 15-112 does NOT reach the Medicaid HealthChoice MCOs or the BH ASO (Carelon). Medicaid credentialing is governed by the HealthChoice MCO Agreement, COMAR 10.67 and 42 CFR 455 instead. Do not invoke the 30/120-day clock against an MCO or the ASO.

Md. Code, Insurance § 15-112 (official text) via kb/states/md.md · checked Jul 2026

Maryland is the strict case: clinicians who are not independently licensed (LGPC, LMSW, LMFT, LGADC, LCSW. Note LCSW-C is the independent social work license) cannot enroll individually in Maryland Medicaid, cannot be paid in individual or group practice, and their supervisors cannot bill for them either. The only door is a licensed facility (e.g. an OMHC): facilities may be reimbursed for services delivered by supervised, not-yet-independent staff. Going solo is a dead end until full independent licensure.

Carelon Maryland PBHS Provider Manual v3 via kb/states/md.md · checked Jul 2026

Master's-level behavioral health licensure sits in two Maryland boards: the Board of Professional Counselors and Therapists (LGPC entry/supervised, LCPC independent, plus LGMFT/LCMFT and LGADC/LCADC) and the Board of Social Work Examiners (LMSW, LCSW, and LCSW-C, the independent clinical license). The BOPC's online application system launched July 1, 2026; no paper or emailed applications are accepted after June 20, 2026.

MD Board of Professional Counselors and Therapists via kb/states/md.md · checked Jul 2026

Maryland has enacted the Counseling Compact but is not yet issuing or receiving privileges. As of July 2026 the live compact states are only AZ, GA, IN, LA, MN and OH. Compact status is volatile; re-check before relying on it.

counselingcompact.gov via kb/states/md.md · checked Jul 2026