Complete Maryland Medical Billing Checklist for New Providers

Launching a medical practice in Maryland is an exciting milestone, but getting paid for your services is an entirely different challenge. Between complex payer requirements, state-specific regulations, and HIPAA compliance, new providers can feel overwhelmed quickly.

Whether you’re a solo therapist, chiropractor, internist, or part of a growing group practice, having a clear, step-by-step medical billing checklist is essential to avoid delays, denials, and compliance issues. Discover how our Maryland medical billing services help increase collections and reduce delays—so you get paid faster, every time.

Here’s your complete Maryland medical billing checklist—built to guide new providers from credentialing to collections with clarity and confidence.

Step 1: Set Up Your Legal & Financial Foundation

Before billing any payer, ensure your practice is properly structured:

• Register your business with the Maryland Department of Assessments and Taxation
• Apply for an EIN through the IRS (this will be your Tax ID)
• Secure malpractice insurance
• Open a business bank account to receive insurance reimbursements and patient payments
• Establish a physical or virtual address (PO Boxes aren’t always accepted by payers)

Tip: Some payers require a physical practice location for enrollment, even if you provide telehealth.

Step 2: Obtain Your NPI & State Licensure

You’ll need two types of National Provider Identifiers (NPIs):

• Type 1 NPI (Individual): For the provider rendering services
• Type 2 NPI (Organizational): For billing under your practice name or group

Also, make sure your Maryland medical license is active and up to date with the Maryland Board of Physicians (or the relevant board for your discipline).

Thinking of outsourcing? Learn why choosing a local medical billing partner in Maryland might be the strategic move your practice needs.

Step 3: Credentialing & Payer Enrollment

This is the most time-sensitive and error-prone step, and the one that delays reimbursement if not done correctly.

Enroll With:

• Maryland Medicaid via the Maryland Medicaid Provider Enrollment Portal (ePREP)
• Medicaid MCOs such as Amerigroup, Priority Partners, Maryland Physicians Care, Aetna Better Health
• Commercial payers (CareFirst, Aetna, Cigna, UHC, BCBS, etc.)

Requirements Typically Include:

• CAQH profile (keep it current and attested)
• Licensure documentation
• Malpractice insurance
• Practice address and TIN
• NPI numbers
• W-9 form

Average credentialing time: 45–120 days, depending on the payer.

Pro tip: Let a professional billing company like Global Tech Billing LLC handle this for you to avoid costly delays.

Step 4: Choose Your Billing & Practice Management Software

Maryland payers require clean, compliant claim submissions via EDI. You’ll need:

• EHR/PM software compatible with Maryland payers (e.g., AdvancedMD, Kareo, Office Ally, SimplePractice)
• Integrated clearinghouse (Availity, Office Ally, or Change Healthcare)
• Patient billing and payment portal

Features to look for:

• Electronic claims submission
• ERA/EFT setup
• Claims tracking
• SOAP note integration
• Appointment scheduling

If you’re unsure, Global Tech Billing LLC can help set up and manage your software stack.

Step 5: Set Up Fee Schedules & Superbills

Before you can start billing, you need:

• Internal fee schedule for services
• Superbill templates customized by specialty
• Knowledge of CPT and ICD-10 codes is most relevant to your practice
• Understanding of modifiers (especially for therapy, chiropractic, and OB/GYN services)

Also, consider the Medicare Physician Fee Schedule as a benchmark—even if you don’t accept Medicare.

Tip: Keep a regularly updated “cheat sheet” of your top 20 billed codes and coverage notes by payer. Make an informed decision for your revenue cycle—read our guide on how to choose the right medical billing provider in Maryland.

Step 6: Enroll for ERA/EFT with Payers

ERAs (Electronic Remittance Advice) and EFTs (Electronic Funds Transfer) allow you to:

• Receive payment directly to your bank
• Automatically post remits in your billing system
• Reduce check-related payment delays

Each payer has its portal for setup. This is mandatory if you want to streamline revenue collection.

Step 7: Understand Maryland-Specific Rules

Maryland has several unique regulations to be aware of:

• All-Payer Model (HSCRC): Impacts hospital billing rates and insurance reimbursement transparency
• Telehealth laws: Maryland has favorable telehealth parity laws, but payers still vary in reimbursement
• Prior Authorization Reform: As of 2023, Maryland law requires more transparency from payers around prior auth decisions
• Balance Billing Restrictions: Especially for Medicaid and MCOs, ensure you know when balance billing is prohibited

Tip: Check with the Maryland Insurance Administration (MIA) for regular policy updates.

Know what to expect before you commit. Here’s what a professional medical billing service in Maryland should deliver to help your practice thrive.

Step 8: Train Your Staff (or Outsource to Experts)

Billing isn’t just about submitting claims—it’s about:

• Ensuring eligibility before every visit
• Capturing accurate documentation
• Using correct coding
• Managing denials and appeals
• Communicating with patients about balances

If you’re a solo or small group provider, outsourcing billing may be more cost-effective and accurate than hiring and training an in-house team.

Step 9: Go Live & Start Billing

Once credentialing is complete and your software is operational:

• Begin submitting claims daily
• Track denials and rejections in real time
• Monitor KPIs like clean claim rate, average reimbursement time, and denial rate
• Start collecting patient balances through statements, online portals, or phone follow-ups

This is also when you begin to discover payer quirks and process gaps, which is why expert guidance is valuable.

Step 10: Stay Compliant and Improve Continuously

• Perform monthly audits
• Update coding with annual CPT/ICD revisions
• Ensure HIPAA compliance in patient communications and data handling
• Review financial reports regularly
• Renew insurance credentials before expiration

A billing partner like Global Tech Billing LLC will handle compliance and reporting while helping you grow your practice.

Final Thoughts

Setting up medical billing as a new provider in Maryland isn’t just about software and claims—it’s about laying the groundwork for long-term financial success. When done right, you avoid delays, improve patient trust, and collect what you’re owed—without stress.

If the process feels overwhelming, don’t worry—you don’t have to do it alone. Global Tech Billing LLC helps Maryland providers set up billing operations from scratch, ensuring accuracy, compliance, and profitability every step of the way.

Ready to simplify your billing and start getting paid on time? Visit our Maryland Medical Billing Services page to see how Global Tech Billing LLC can set up and manage your billing from day one—accurately, compliantly, and stress-free.

FAQs

1. How long does it take to get credentialed with Maryland Medicaid?

Enrollment with Maryland Medicaid and MCOs typically takes 45 to 90 days, depending on the accuracy of your application and supporting documents.

2. Can I start seeing patients before credentialing is complete?

Yes, but unless you’re billing under a supervising provider, you may have to hold or write off claims. Some payers allow retroactive billing, but not all.

3. What’s the difference between NPI Type 1 and Type 2?

NPI Type 1 is for individual providers; NPI Type 2 is for organizations or group practices that bill under a separate Tax ID.

4. Do I need special billing software to operate in Maryland?

Yes, your software should support Maryland’s payer requirements, clearinghouse integrations, and HIPAA compliance. Many EMRs offer built-in billing, but not all are payer-compliant.

5. Should I hire a biller or outsource?

Outsourcing is often more efficient for new or small practices. It eliminates training, reduces errors, and ensures claims are submitted by experienced professionals familiar with Maryland regulations.