What is PRP billing in Maryland?

PRP (Psychiatric Rehabilitation Program) billing in Maryland is the process of submitting monthly Medicaid claims for face-to-face rehabilitation services delivered to individuals with a serious emotional disturbance or serious and persistent mental disorder. Claims are billed at a monthly rate supported by encounter data.

Why are Maryland PRP claims being denied in 2026?

As of January 1, 2026, Maryland Medicaid denies all PRP claims when the referring provider is not actively enrolled with Maryland Medicaid. The referring provider's NPI must appear on every monthly claim, or the claim is denied.

Can an LMSW or LGPC be the referring provider for PRP services?

No. Licensed master social workers (LMSW) and licensed graduate professional counselors (LGPC) cannot enroll with Maryland Medicaid as individual providers. For PRP referrals, the supervising licensed practitioner's NPI must be used on the referral form and claim.

Who handles Maryland Medicaid PRP billing?

IOU Billing handles Maryland Medicaid PRP billing for psychiatric rehabilitation programs statewide. The team includes former Carelon staff familiar with Maryland's behavioral health Medicaid rules, authorization process, and monthly encounter requirements.

Coronavirus Covid-19 attack. Covid corona virus cells attacking lungs

The Impact of COVID-19 Pandemic on Medical Billing

October 1, 2020

covid-19

The COVID-19 pandemic has had a massive impact on all aspects of daily life, safety, and financial and emotional well being. The impact of COVID-19 on medical billing is significant as well as you must now adjust to new billing and payment tracking updates while striving to continue to provide stellar service to your patients.

The COVID-19 Pandemic has created the following medical billing challenges:

new tracking and billing updates
lack of resources strains healthcare practice
an increase in the number of denied claims
states are taking action to protect against surprise medical billing
revenue cycle impacts

IOU Billing Blog Post

This article is provided by IOU Billing for general informational purposes only and does not constitute legal, compliance, coding, or reimbursement advice. Payer rules, Medicaid requirements, and billing regulations change frequently and vary by state and plan, so providers should verify current requirements with the applicable payer or a qualified professional before acting on any information here.