Please review the latest instructions for processing Retro-Eligibility cases for Acute reviews. Maryland Department of Health is requesting that providers attach a copy of the Retro-Eligibility Decision Form to all UB04’s submitted for retro-eligibility cases in order to avoid having the claim deny for timely filing. When submitting a claim for dates of service more than a year old, the UB04 must be submitted to the Department on paper.

Retro Eligibility Decision Form

Retro Eligibility Instructions