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COMAR 10.09.24.03
398 State of Maryland Medical Assistance Manual Revised July 2012
MARYLAND MEDICAL ASSISTANCE PROGRAM Letter of Instructions on Reimbursement/Payment For Medical Expenses under the Pickle Amendment
Date of Letter:
Case Number:
Dear:
The attached letter indicates that you have been found eligible for Medicaid for the period / through /
/ . If during this period you made payment for medical services, you may be reimbursed if you provide written materials showing the type of service received, by whom it was provided, the amount charged and the amount you paid. This information should be obtained from the provider of the services, e.g., your physician, hospital, pharmacy, and should be sent to:
Division of Eligibility Services Medical Assistance Policy 201 West Preston Street Baltimore, Maryland 21201
If during this period for which you were eligible for Medicaid, you received services for which you did not make payment, please advise the provider of services that he should submit a claim to Medicaid in the usual fashion.
All claims and supporting materials must be received no later than 45 days from the date of this letter. Payment will be made only for services covered under the Medicaid State Plan in effect at the time the services were provided and only in the amount allowable under the State Plan.
If you have questions on how to seek reimbursement for yourself or payment for the provider of services, please call 410-767- 1463. Please indicate that you calling concerning reimbursement for medical services under the Pickle Amendment.
Sincerely,
Case Manager
Department of Social Services
Telephone Number