Is there a medical billing company near me in Baltimore that specializes in behavioral health?

Yes. Maryland Medical Billers is a Baltimore-based medical billing company that specializes in behavioral health, mental health, and therapy practice billing for providers across the Baltimore metro area, surrounding Maryland counties, and Washington DC.

How much does a medical billing service cost for a small therapy practice?

Maryland Medical Billers uses a performance-based pricing model, charging 6% to 8% of monthly collections rather than a flat fee. This means the billing company is paid only when the practice gets paid.

What is the difference between provider credentialing and insurance credentialing?

Provider credentialing verifies a clinician's qualifications, such as licensure and education, with payers and institutions. Insurance credentialing is the process of enrolling a provider with specific insurance networks, including CAQH attestation and ePREP enrollment, so claims can be reimbursed under that network.

Can a medical billing company help reduce claim denials for mental health practices?

Yes. A dedicated denial management process identifies the root causes of rejected claims, such as timely filing errors or incomplete credentialing, and resubmits corrected claims to improve first-pass rates and recover outstanding accounts receivable.

Why should a Maryland therapy practice outsource billing instead of handling it in-house?

Outsourcing billing to a specialized firm like Maryland Medical Billers gives small and mid-sized practices access to expertise in payer-specific rules, such as Carelon Behavioral Health of Maryland requirements, without the overhead of hiring and training in-house billing staff.

Carelon ASO Transition Guide | Maryland Medical Billers | Baltimore MD

If your practice bills Maryland Medicaid for behavioral health services, you already know the administrative services organization changed at the start of 2025. Carelon Behavioral Health took over as Maryland’s behavioral health ASO, replacing Optum, and that shift touched nearly every part of how behavioral health claims move through the system. Maryland Medical Billers has spent the past year helping behavioral health and mental health practices across the Baltimore metro area adjust to the new workflow, and this article walks through what actually changed and what providers still need to watch closely.

Why the ASO Changed in the First Place

Maryland’s Medicaid behavioral health system has operated under a carve out model since 2015, meaning specialty mental health and substance use disorder services are managed separately from physical health through a dedicated administrative services organization. The Maryland Department of Health rebid this contract, and after a competitive process, the Board of Public Works approved Carelon Behavioral Health to take over as the state’s behavioral health ASO. The contract officially began January 1, 2025, ending Optum’s role managing authorizations, claims, and provider relations for behavioral health Medicaid services.

What Stayed the Same

It helps to start with what did not change, because this is where a lot of practices get unnecessarily nervous. Review guidelines and clinical authorization time spans remained the same through the transition. The underlying Medicaid behavioral health benefit structure, including services like outpatient mental health, psychiatric rehabilitation, and substance use disorder treatment, was not redesigned. Providers still enroll through ePREP before rendering services, and the basic relationship between the nine HealthChoice MCOs handling physical health and the behavioral health ASO handling specialty claims remains intact.

What Actually Changed for Providers

The practical changes are mostly administrative, but they matter:

Claims for dates of service on or after January 1, 2025 go to Carelon instead of Optum
Providers needed to register for a new Carelon ID and set up accounts in ProviderConnect and Availity
Open authorizations migrated into Carelon’s system, with some practices reporting a need to confirm status directly
A new provider alert and provider update communication structure rolled out, separating urgent alerts from general updates
Carelon has continued making incremental system changes since go live, including updates to how certain authorization and provider/vendor combination errors are flagged

That last point matters most for ongoing billing accuracy. Carelon has issued provider alerts addressing issues like claims denied for no authorization on file due to authorization class and service code mismatches, which is exactly the kind of denial pattern that shows up after a system transition like this one.

Common Billing Disruptions Practices Have Reported

Behavioral health practices in Baltimore City, Howard County, and across Anne Arundel County have described a handful of recurring issues since the transition. Authorizations that did not migrate cleanly led to a wave of denied claims that required direct follow up with Carelon to resolve. Some practices found their provider information needed to be re-verified in the new system before claims would process correctly. Others ran into confusion over which portal, ProviderConnect or Availity, to use for specific tasks.

None of these issues are unusual for a system transition of this size. Optum’s own takeover years earlier had similar growing pains. What matters now is making sure your practice’s billing workflow is fully aligned with how Carelon actually operates today, not how Optum used to operate.

How to Keep Your Behavioral Health Claims Moving Smoothly

A few practical steps help reduce friction with the current system:

Confirm your Carelon ID and provider registration are active in both ProviderConnect and Availity
Verify open authorizations directly in Carelon’s system rather than assuming a clean migration
Sign up for Carelon provider alerts so your billing staff sees urgent claim and authorization updates as they happen
Track denial patterns closely, since authorization class and service code mismatches have been a documented issue since the transition
Review timely filing deadlines, since Maryland’s behavioral health claims generally require submission within 12 months of the date of service

Why This Matters Beyond Just Claims Processing

A behavioral health ASO transition does not just change where a claim gets sent. It changes utilization management, authorization workflows, and provider communication, all of which affect how quickly a practice gets paid. Practices in Harford County and across the broader Baltimore metro area that treated this as a simple address change for claims submission, rather than a full operational shift, are the ones still chasing denied claims today.

Where Maryland Medical Billers Fits In

Behavioral health providers may interact with Carelon Behavioral Health of Maryland, which serves as the state’s ASO for Medicaid participants receiving behavioral healthcare. Maryland Medical Billers tracks Carelon’s evolving requirements directly and helps practices correct denials tied to the transition, verify authorization status, and keep claims submission aligned with current ASO workflows rather than outdated assumptions left over from the Optum era.

Frequently Asked Questions

When did Carelon officially take over as Maryland’s behavioral health ASO? Carelon became Maryland’s behavioral health administrative services organization on January 1, 2025, succeeding Optum.

Do I need a new login to bill through Carelon’s system? Yes. Providers needed to register for a new Carelon ID and create new accounts in ProviderConnect, even if they previously had login credentials with Optum or Beacon.

Did clinical authorization rules change with the transition? No. Review guidelines and authorization time spans remained the same through the transition to Carelon.

Can you help with denied claims tied to the ASO transition? Yes. Denial management is one of the core services. This includes reviewing denied claims, identifying the reason for denial, correcting claim issues, resubmitting when appropriate, and helping practices reduce repeated billing errors.

Do you help behavioral health practices navigate Carelon specifically? Yes. Behavioral health providers in Maryland may interact with Carelon Behavioral Health of Maryland, which serves as Maryland’s ASO for Medicaid participants receiving behavioral healthcare. Maryland Medical Billers positions itself as a billing support resource for providers navigating these claims and administrative requirements.

Who This Service Is For

Small medical practices
Mental health practices
Behavioral health providers
Therapists and counselors
Psychiatrists and psychiatric nurse practitioners
Group practices and expanding private practices

What We Provide

Medical billing and claims submission
Claims follow-up and denial management
Payment posting and AR follow-up
Insurance verification and eligibility checks
Provider credentialing and payer enrollment
Revenue cycle reporting and billing cleanup

Related Resources

Contact Us

Request a free medical billing consultation and find out where your practice may be losing revenue. Call (410) 874-0176 today.

Supporting Maryland Communities Through Local Sponsorship

Maryland Medical Billers is a proud sponsor of community events throughout the state of Maryland. As your local medical billing specialists, we believe in giving back to the communities we serve, including Baltimore City, Baltimore County, Anne Arundel County, and Howard County, along with surrounding areas.

Our Maryland Community Commitment

From Baltimore summer festivals to local charity fundraisers, we actively support events that bring Maryland families together. Funding goes toward school programs, community celebrations, and neighborhood improvement initiatives that strengthen our region.

Discover Local Events

Looking for family-friendly activities in Maryland? Visit Maryland Free Events for listings of sponsored gatherings, festivals, and activities throughout the state.

Choosing Maryland Medical Billers for your billing needs means supporting a local business that reinvests in Maryland communities. Contact us today or call (410) 874-0176 to learn more about our expert medical billing services.