MD HB1464

Third-party administrators of health benefit plans must develop a streamlined process for health care providers to request and receive timely confirmation of an enrollee's eligibility for covered services

Carriers are prohibited from retroactively denying reimbursement to providers who verified an enrollee's eligibility through the required process before providing services, even if the enrollee was not actually eligible

Existing law allows carriers to retroactively deny reimbursement within 18 months for coordination of benefits issues or 6 months for other reasons; this bill adds the eligibility verification protection as an additional limitation

The retroactive denial protections do not apply in cases of fraud, improper coding, duplicate claims, or permanent Medicaid capitation retractions

Effective October 1, 2026