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Maryland

Maryland Behavioral Health Credentialing And Payer Enrollment

If you’re a behavioral health provider getting credentialed in Maryland, MPRIME is now open for Medicaid enrollment. The Medicaid path is two steps, the state and then Carelon, since specialty behavioral health is carved out of the HealthChoice MCOs and paid fee-for-service. Commercial applications can move alongside Medicaid enrollment. Here is the order and what only you can sign.

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Maryland Payers And Timelines

Maryland Medicaid Enrollment Through MPRIME

Maryland Medicaid opened MPRIME on October 13, 2026. Create a new user account and associate it with your provider profile before taking action. See the Maryland Department of Health launch notice for the current enrollment instructions and deadlines.

  • Keep your application or enrollment number, your provider and group records, the documents you’ve submitted, anything still outstanding and the latest status.
  • Check which individual and practice records the services you provide require.
  • Keep state enrollment and plan participation apart. Each patient and service sits in a specific Medicaid program, health plan and behavioral health arrangement, and that’s the one you verify.
  • Give one person on your staff the portal notices, the requests for missing information, the transition instructions and the written effective dates, so nothing sits.

A portal registration isn’t a payer approval. Keep the enrollment and network participation evidence together before telling staff a provider is ready to bill.

MPRIME launch notice reviewed October 15, 2026: Maryland Medicaid MPRIME launch instructions.

Where The Delays Happen

Getting On A Panel Isn’t The Same As Getting Paid.

Files rarely stall inside a step. They stall in the gaps between these five, and we work every gap and tell you which one yours is sitting in.

Credentialed›contracted›loaded›connected›payable

Medicaid Is On The State’s Calendar. Commercial Isn’t.

Two Tracks

That’s the sequencing decision in Maryland this year. Commercial work can start today whatever the portal is doing, so we run it while the Medicaid side waits for its window.

Maryland Medicaid

Enroll With The State, Register With Carelon, Stop.

More than 85 percent of Maryland Medicaid participants sit in HealthChoice, the mandatory managed care program, where nine MCOs cover physical health, pharmacy and the primary behavioral health a PCP delivers. Specialty mental health and substance use care is carved out of that benefit package and paid fee-for-service by the statewide administrator. So for a psychiatrist, a PMHNP or a therapist, the Medicaid payer is usually the Public Behavioral Health System, not the plan on the member’s card.

How you enrollIn MPRIME, the enrollment portal that replaced ePREP on October 13, 2026, under the provider type that matches how you bill, signing the provider agreement and whichever addenda your provider type requires. Maryland assigns your MA number when the application is approved and processed. Carelon is direct about the order: you may not render behavioral health services under the state system until you’re enrolled in Maryland Medicaid.
Then CarelonRegister with the Provider Digital Front Door, which is ProviderConnect reached through the Maryland Public Behavioral Health System space in Availity Essentials. That’s where authorizations and claims work happens. Groups use an Account Request Form to put everyone under one account, and Carelon requires a group to include at least one independently licensed provider who is enrolled in Medicaid.
Forms you’ll see

Maryland Medicaid Provider AgreementProvider-type addendaORP enrollment, type 92Carelon Account Request Form

One NPI is rarely enoughMaryland requires a separate NPI and MA number for each approved or licensed service, and for the same service at more than one location. A practice running an outpatient mental health clinic, a psychiatric rehabilitation program and an opioid treatment program at one address needs three sets. Three separately licensed clinics in three towns need three more. Tell us every program and every address up front.
Two hard edgesCarelon says the effective date of your account is the date the completed application was processed, and that providers are at financial risk for services delivered before their MA number is active and for services the administrator hasn’t authorized. Nothing backdates that. Local behavioral health authorities, the local systems managers formerly called Core Service Agencies, handle local coordination and some grant-funded work. They are not the payer, and it’s easy to mistake one for the other.

Commercial

Maryland Tells Carriers Which Form To Accept, And It’s CAQH.

CareFirst is the contract that does the most work here. It’s the largest carrier in the region and its network covers Maryland, Washington DC and Northern Virginia, which is one metro market rather than three states of paperwork. Under Insurance 15-112(g)(3) a carrier has 30 days after a completed application to send written notice that it’s continuing to process or rejecting you, then 120 days from that notice to decide and notify you in writing.

Your CAQH stays yoursYou complete and attest your own profile. We’re added as an authorized practice manager, so we keep the practice data current during your project and get each payer authorized. After that, Credentialing Maintenance keeps it current. If you want us to maintain your profile, you share access securely and change the password when we’re done. Under Insurance 15-112.1 the Commissioner designates a uniform credentialing form and carriers must accept it as the sole application, and the Maryland Insurance Administration designated CAQH in Bulletin 09-25. Re-attest every 120 days.
Behavioral health has its own doorOptum for UnitedHealthcare, started in Provider Express. Evernorth for Cigna. In house at Aetna, on the same request for participation as medical. In house at CareFirst, which ended its Magellan Healthcare arrangement on April 1, 2018, and in house at Johns Hopkins Health Plans and Kaiser Permanente. Using the wrong application route can delay enrollment.
A CareFirst rule to settle before you applyCareFirst requires everyone in the same practice to participate in the same networks, so BlueChoice and Regional Preferred is a practice-level decision rather than a clinician-by-clinician one. It also uses CAQH as its credentialing verification organization and doesn’t accept paper, wants directory information confirmed every 90 days, and recredentials every three years.
Already on the calendarSenate Bill 808 of 2026, signed as Chapter 706, takes effect January 1, 2027. It eliminates application fees for providers applying to carrier panels, tightens carrier notice requirements with civil penalties attached, requires carriers to keep directories current, and changes which credentialing applications the Commissioner may designate. We re-verify against the final regulations before it lands.
Seeing patients in DC or VirginiaOne CareFirst contract reaches Blue members who live elsewhere through BlueCard, and Aetna, Cigna with Evernorth, and UnitedHealthcare with Optum are national. The gate is a license where the patient is sitting. Say during onboarding if you hold a DC or Virginia license, because in this market that changes which single contract covers your whole panel.

Who You’ll Apply To, And How Long It Usually Takes.

Maryland Commercial Payers

These are typical ranges from a complete application, inside Maryland’s 30-day notice and 120-day decision clock. Payers control their own timelines, so we track them rather than promise them.

CareFirst BlueCross BlueShield

BlueChoice, Regional Preferred, the state employee plans, and the whole DC metro
  • Usually: 60 to 120 days from a complete file, with the statutory 30-day notice and 120-day decision sitting behind it. Recredentialing every three years
  • How it goes in: a CAQH profile with CareFirst authorized, plus the CareFirst questionnaire that matches your provider type. No paper. Group requests also want the tax ID, W-9 and a practitioner roster with NPIs, licenses and insurance
  • Behavioral health: managed in house since April 1, 2018, when CareFirst ended the Magellan Healthcare arrangement. Authorizations run through the CareFirst provider portal
  • Watch: everyone in the practice has to be in the same networks, so decide BlueChoice and Regional Preferred before anyone applies

UnitedHealthcare And Optum

The clearest open door in the state
  • Usually: 60 to 120 days from a complete application, started inside Provider Express with Join Our Network. Separate from core UnitedHealthcare medical
  • Why it’s a strong first application: Optum’s Maryland page says it recognizes Maryland as an any willing provider state and lists prescribers as sought in all counties, along with telemental health, medication assisted treatment prescribers, child and adolescent specialists, and Express Access providers who can see someone within five business days
  • Watch: UnitedHealthcare Community Plan of Maryland is a separate contract from commercial and from Optum’s behavioral network

Separate door: Optum Behavioral Health

Aetna

Behavioral health in house, on the same form as medical
  • Usually: a request for participation first, an answer on network need and eligibility, then credentialing pulled from CAQH, then contracting. Commonly 60 to 120 days from start to finish. Recredentialing generally every 36 months
  • Path: behavioral health clinicians use the same Aetna request for participation as medical professionals
  • Watch: Aetna Better Health of Maryland is Medicaid and a different contract from commercial Aetna

Johns Hopkins Health Plans

One relationship, four lines of business
  • Usually: no published standard turnaround, and Maryland’s 30-day notice and 120-day decision clock applies to its commercial lines. Getting in the door starts with a Letter of Interest to Provider Relations rather than a portal application
  • How it goes in: CAQH with Johns Hopkins Health Plans authorized. The plan can send a CAQH invitation at no cost to a practitioner who isn’t a member yet
  • Why it matters: in the Baltimore corridor a meaningful share of employed patients carry Employer Health Programs. It also runs the US Family Health Plan, Advantage MD and Priority Partners
  • Watch: Priority Partners is the Medicaid line and a separate contract. Being loaded for one line isn’t being loaded for all four, so confirm exactly which lines your agreement names

Kaiser Permanente Of The Mid-Atlantic States

Worth asking about, contrary to the usual assumption
  • Usually: no published turnaround, because the gate is network need rather than a queue. Confirm at the point they engage
  • Why it’s here: don’t carry over the assumption that Kaiser is closed to outside clinicians. The Mid-Atlantic region serves Maryland, DC, Northern Virginia and parts of West Virginia and runs a community provider network with its own portal, manual and behavioral health chapter, so contracted outside clinicians do see Kaiser members
  • Watch: claims run on a 180-day timely filing window, tighter than several carriers here

Cigna Healthcare And Evernorth

Behavioral health goes through Evernorth
  • Current application route: Since September 1, 2026, individual providers in Maryland apply through the Evernorth provider portal. Clinic and facility applications follow separate instructions. We match you to the right provider category and its network requirements before anything goes in.
  • Usually: up to about 90 days to join the behavioral network once it’s open, with CAQH re-attestation every 120 days
  • What we do: we include it in your opening set. Evernorth was accepting individual applications through its provider portal when we checked on September 26, 2026

Separate door: Evernorth Behavioral Health

Two Maryland names changed and the old ones are still in circulation. Wellpoint Maryland is the plan formerly called Amerigroup Community Care, and CareFirst Community Health Plan Maryland was University of Maryland Health Partners, so older directories, contracts and billing guides name entities that have moved. On the behavioral health side, Optum Maryland has not run the Public Behavioral Health System since December 2024, and Magellan Healthcare has not run CareFirst behavioral health since April 2018. If a checklist names either one, it’s stale. Medicare, and Maryland Medicaid including the Carelon-administered behavioral health system and the HealthChoice MCOs, are government enrollment, which is $450 per provider for each Medicare, Medicaid or Medicaid plan enrollment and can be bought on its own or with a package.

Carry A Plan We Didn’t List? Add It.

The State of Maryland Employee and Retiree Health and Welfare Benefits Program is a large self-funded book administered by commercial carriers rather than a plan you contract with directly, and CareFirst is one of the administrators. You reach those members through the administering carrier’s network, which is a practical argument for holding CareFirst even when your commercial mix looks light on Blue. Local behavioral health authorities, the local systems managers formerly called Core Service Agencies, aren’t payers for routine outpatient Medicaid work, and we identify yours so a local approval doesn’t get mistaken for a payer contract or the other way around. Baltimore City doesn’t work like Montgomery County. And Maryland Taft-Hartley funds in the building trades and UFCW-affiliated world are usually reached by joining a rented commercial network rather than by contracting with the fund. You name the plan. We find the real route.

Send These Once And We Can Start.

What We Need From You

  • Are you joining a group that already holds the contract?That one answer decides whether the interim payment rule under Insurance 15-112(w) can cover you while credentialing runs, or whether nothing does. It also decides which package fits.
  • Every program and every addressMaryland requires a separate NPI and MA number for each approved or licensed behavioral health service, and for the same service at more than one location. Tell us the full picture up front or we build the wrong enrollment.
  • Your individual NPIPlus the Type 2 if you bill under a group or business, and the taxonomy attached to each.
  • Active Maryland license and DEAAnd tell us if you also hold a DC or Virginia license, because in this market that changes which single commercial contract covers your whole panel.
  • CAQH attested and authorizedYou attest it. We keep it current during your project. In Maryland it carries statutory weight, because CAQH is the Commissioner-designated uniform credentialing form and CareFirst uses it as its verification organization and won’t take paper. Re-attest every 120 days.
  • Delegated access for the Medicaid workSo we can prepare your Maryland Medicaid enrollment and your Carelon ProviderConnect registration without anyone sharing a password. Plus the mailing address and email on your enrollment record, because that’s where revalidation notices go and where Carelon has mailed provider payments.
  • Five years of work historyMonth and year, with any gap over six months explained. This is the single most common reason a CAQH-driven file gets sent back.
  • Malpractice certificateThe current declarations page naming you. It’s also one of the conditions in the group-practice interim payment rule.
  • Legal business name, EIN, and W-9One per tax ID. CareFirst also asks for a practitioner roster with NPIs and licenses on group requests.

Depending on what you plan to bill, Maryland may want the practice itself licensed as a behavioral health program, separately from your own license. The state’s term is a community-based behavioral health program license from the Behavioral Health Administration under COMAR Title 10, Subtitle 63, and several of those categories are accreditation-based. Two payer-side signals point at it: Carelon’s manual says behavioral health programs need to be accredited and licensed to qualify as a Medicaid provider while individual practitioners are covered by their own board, and Carelon’s own join-the-network instructions start with a Behavioral Health Administration licensure application before Medicaid enrollment. It’s a real fork in the road in Maryland, because it changes which Medicaid provider type you enroll under and which enrollment requirements apply to you. A solo prescriber doing outpatient medication management is a different situation from a program. We check it with you during onboarding, before it can stall a payer contract. We don’t give legal advice and we don’t file it for you.

We handle credentialing and payer enrollment in Maryland and in the other 49. Physicians and outpatient medical groups, psychiatrists included, start on the physician credentialing page.

You Answer Once. We Do The Paperwork.

How It Works

Buy The Package

Published price and scope. No call needed.

One Onboarding Packet

Short and guided. It asks more only where your answers call for it, starting with your provider type and the current Maryland enrollment requirements.

We Prepare Everything

The Medicaid enrollment, the Carelon registration and every commercial file, built from what you told us.

You Review And Sign

Read it, change anything, sign. Nothing goes out until you say so.

We Submit And Track

Every purchase includes Command Suite, so you can see where each payer application stands, what we’re working on, what’s waiting on a payer, and what we still need from you.

What We Stand Behind

Payer decisions, timing and rates aren’t ours to promise, and we don’t promise them. Our own work is a different matter. If something we delivered doesn’t work the way we said it would, tell us within 30 days of delivery and we fix it at no cost. If we can’t fix it, or can’t deliver what you bought, we refund the part it affected. Payments aren’t refundable unless the problem is our mistake. A new request, another payer or provider, a change of scope or a new build gets quoted separately.

Everything Stays In Your Name

Your NPPES record, CAQH/DataSpring profile, Maryland Medicaid enrollment and payer contracts stay in your name, and the paperwork is yours too. You keep all of it if we stop working together.

Maryland Credentialing Questions

Questions We Get

Can I Still Enroll With Maryland Medicaid Right Now?
Yes. Maryland Medicaid opened MPRIME on October 13, 2026, replacing ePREP. Each user needs a new login and must associate it with the provider profile. ePREP logins do not transfer. Use the provider type that matches your work, and check current state requirements before submitting. Approval and effective dates still come from Maryland Medicaid.
What Happens To EPREP When MPRIME Goes Live?
MPRIME is now the enrollment portal. Maryland says a complete, processable application submitted by December 31, 2026 is eligible for an effective date backdated to the later of the application hold date or the license issuance date. Do not submit claims for that period until the enrollment application is approved. Missing the deadline means no backdate.
Do I Have To Contract With All Nine HealthChoice MCOs?
For behavioral health, usually not. Maryland carves specialty mental health and substance use services out of the managed care benefit package entirely and administers them statewide, fee-for-service, through one administrative services organization. Carelon Behavioral Health of Maryland has held that role since January 1, 2025, replacing Optum Maryland. So for most prescribers the Medicaid path is two steps rather than nine: enroll with Maryland Medicaid, then register with Carelon through the Provider Digital Front Door, which is ProviderConnect reached inside the Maryland Public Behavioral Health System space in Availity Essentials. The nine HealthChoice MCOs matter only for services the MCOs cover. Any guide telling you to bill an MCO for specialty behavioral health is out of date, and so is any instruction naming Optum Maryland.
Will A Maryland Carrier Pay Me While My Credentialing Is Still Pending?
Only through a group. Under Md. Code, Insurance 15-112(w) a carrier has to pay a participating group practice at the participating provider rate for covered services delivered by a clinician who isn’t credentialed yet, as long as that clinician is employed by or a member of the group, has applied, has received the carrier’s notice of intent to continue processing, holds a valid Maryland license, and meets the hospital-credentialing or liability-insurance condition. Payment runs from the date of that intent-to-process notice through the date the final decision is sent. Read the practical version. If you’re joining a group that already holds the contract, Maryland law can keep the lights on while your file is pending. If you’re solo and building your first panels, that protection doesn’t reach you at all, which is a real argument for filing early rather than waiting for a start date.
Does Maryland Make Carriers Accept The CAQH Application?
Yes, and it’s unusual. Under Insurance 15-112.1 the Insurance Commissioner designates a uniform credentialing form, a carrier or its credentialing intermediary has to accept that form as the sole application for credentialing and recredentialing, the form has to be free to providers, and the Commissioner can fine a carrier that doesn’t comply. The Maryland Insurance Administration designated the CAQH form in Bulletin 09-25. So an unattested CAQH profile in Maryland isn’t housekeeping, it blocks every commercial application at once. One change is already on the calendar: Senate Bill 808 of 2026, signed as Chapter 706, takes effect January 1, 2027 and alters which credentialing applications the Commissioner may designate, alongside eliminating panel application fees and tightening carrier notice requirements.
Do I Need A Separate Contract For Patients In DC Or Northern Virginia?
Usually not, because this is one metro market rather than three states of paperwork. CareFirst holds the Blue license across Maryland, Washington DC and Northern Virginia, and Kaiser Permanente’s Mid-Atlantic region covers roughly the same footprint. National carriers work the same way: one Aetna, one Cigna and Evernorth, one UnitedHealthcare and Optum contract covers every state you’re licensed in. The gate to a patient in DC or Virginia is a license where that patient is sitting, not a second payer contract. Tell us during onboarding if you hold more than one of the three licenses, because it changes which single contract covers your whole panel. Medicaid is the genuine exception, and joining another state’s network is its own question again.
How Long Does A Maryland Carrier Have To Decide?
Thirty days for a first written notice, then 120 days to decide, under Insurance 15-112(g)(3). The carrier has 30 days after receiving a completed credentialing application to send written notice that it’s continuing to process the application or rejecting it, then 120 days from that notice to accept or reject you and send written notice of the decision. In practice a complete commercial file commonly runs 60 to 120 days. That first notice does double duty for anyone joining a group, because it’s what starts the interim payment right under 15-112(w). Keep it, and keep the date on it.
Where Does A Behavioral Health Application Go At Each Maryland Carrier?
It varies by carrier here. Optum for UnitedHealthcare, started inside Provider Express. Evernorth for Cigna, using the individual provider portal or the applicable clinic or facility application. In house at Aetna, on the same request for participation as medical. CareFirst, Johns Hopkins Health Plans and Kaiser Permanente handle behavioral health inside the plan, and CareFirst specifically ended its Magellan Healthcare arrangement on April 1, 2018, so authorizations run through CareFirst’s own provider portal. On the Medicaid side the behavioral health door is Carelon, not the member’s MCO. Using the wrong application route can delay enrollment.

Related

Keep Reading

Maryland PMHNP scope of practiceWhat Maryland allows you to do, separate from who pays you.
Washington DC credentialingDC law makes CAQH the single form every insurer has to accept.
Virginia credentialingA split Blue state, with CareFirst holding the Northern Virginia corner.
Pennsylvania credentialingMedicaid behavioral health is carved out county by county.
West Virginia credentialingFour Mountain Health Trust plans, and a statute that pays you during the wait.
Opening your own practiceBusiness setup, identifiers, payers, EHR, and billing setup.
Adding a provider to your clinicFirst-time credentialing into contracts you already hold, which is the case Maryland’s interim payment rule was written for.
Changing your business or tax IDMoving panels without breaking the money.

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Price it per payer and start with as few as one, from $450 per payer, per provider. Fill out the onboarding packet and we’ll confirm the enrollment path for your provider type, then manage the commercial applications and any selected Medicaid enrollment together.

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Official Pages For Maryland

Maryland Medicaid Provider Enrollment (MPRIME)Enroll or revalidate as a Medicaid provider.Maryland Insurance Administration Provider CredentialingThe state's credentialing rules for health insurers.Maryland Board of NursingNurse practitioner (APRN) licensing.Maryland Board of Professional Counselors and TherapistsLicensing for therapists and counselors.DataSpring Provider Data Portal (formerly CAQH)The credentialing application this state's rules name.

Where This Comes From

  • Maryland Department of Health, PT 36-27: MPRIME launch on October 13, 2026, new logins and enrollment backdates verified October 15, 2026
  • Maryland Department of Health, Maryland Medicaid provider enrollment and the announced MPRIME transition verified October 1, 2026 link checked automatically October 14, 2026
  • Maryland Department of Health, Office of Medicaid Provider Services, General Provider Transmittal No. 115 (PT 59-26, January 29, 2026), the phased ePREP hold and the provider-type lists verified September 26, 2026 link checked automatically October 14, 2026
  • Maryland Department of Health, Office of Medicaid Provider Services, General Provider Transmittal No. 116 (PT 65-26, February 23, 2026), the MPRIME FAQ, early revalidation notices and the 90-day window verified July 26, 2026 link checked automatically October 14, 2026
  • Maryland Department of Health, Office of Medicaid Provider Services, General Provider Transmittal No. 122 (PT 94-26, June 18, 2026), the confirmed hold dates, the backdated enrollment window and the emergency exception, and No. 124 (PT 04-27, July 12, 2026), MPRIME training and the October go-live verified October 1, 2026 link checked automatically October 14, 2026
  • Maryland Department of Health, Office of Medicaid Provider Services, memo of August 21, 2026: temporary NPI registration with Carelon Behavioral Health for courtesy authorizations during the MPRIME transition, and its exclusion of providers under PT 88-26 verified October 1, 2026
  • Maryland Department of Health, Office of Medicaid Provider Services memo, August 21, 2026: the application hold in effect from July to October 2026 and the temporary Carelon registration for courtesy authorizations verified October 1, 2026
  • Carelon Behavioral Health of Maryland, join the network and the Public Behavioral Health System provider manual: enrollment order, ProviderConnect, the Account Request Form, and the separate NPI and MA number per service and location verified July 26, 2026 link checked automatically October 14, 2026
  • Maryland Department of Health, Behavioral Health Administration, Carelon assuming the behavioral health administrator role on January 1, 2025 verified July 26, 2026 link checked automatically October 14, 2026
  • Maryland General Assembly, Md. Code Insurance 15-112: the 30-day notice, the 120-day decision, and the 15-112(w) group-practice participating-rate rule verified October 1, 2026 link checked automatically October 14, 2026
  • Maryland General Assembly, Md. Code Insurance 15-112.1, and Maryland Insurance Administration Bulletin 09-25 designating the CAQH form verified July 26, 2026 link checked automatically October 14, 2026
  • CareFirst BlueCross BlueShield, professional credentialing overview, and the April 1, 2018 notice bringing behavioral health in house verified July 26, 2026 link checked automatically October 14, 2026
  • Optum Provider Express, Maryland any willing provider recognition and prescriber need in all counties verified October 1, 2026 link checked automatically October 14, 2026
  • Evernorth Behavioral Health application instructions: individual providers, clinics, facilities, and regional application routes verified October 1, 2026 link checked automatically October 14, 2026

Links checked automatically on October 14, 2026. A source carries that stamp only when its page loaded and had not changed since the date we verified it.

We last reviewed this page on October 1, 2026. Each source listed shows the date we last verified it, and we will review the whole page again by December 28, 2026.

Payer programs, plans and timelines change, and Maryland is moving faster than most states this year. Everything here carries a verification date and gets re-checked on a review cycle. We will check these facts again by December 28, 2026. Approval and effective dates are controlled by each payer and by the state, and nothing here promises an approval, a timeline or a rate. This page covers payer operations. It isn’t legal, tax or scope of practice advice.

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