MedicaidAdministrativeHigh impact
PT 12-26: Psychiatric Rehabilitation Program Referring Provider Requirements
Maryland Medicaid·MD · Psychiatry·Provider Transmittal
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Starting January 1, 2026, Psychiatric Rehabilitation Program (PRP) providers must include the National Provider Identifier (NPI) of individual referring practitioners on all claims and verify their active Medicaid enrollment status. Claims will be denied if the referring practitioner is not actively enrolled or if a group/facility NPI is used instead of an individual practitioner NPI.
Action Required
By January 1, 2026: Billing team must update billing system to require individual practitioner NPIs (not group/facility NPIs) in Field 17b for all Psychiatric Rehabilitation Program claims. Verify referring practitioner's active Medicaid enrollment using the Provider Verification System before submitting claims. Update workflows to check enrollment status monthly. Claims will be denied if referring practitioner is not actively enrolled or if group NPI is used.