Prior Authorization in Maryland
Soft Home Global provides authorizations submitted ahead of the date of service and chased to a decision for Maryland practices and billing companies at $2,000 per seat per month. Full time, worked during Maryland business hours, inside your own system.
What is specific to Maryland
Maryland is the only state with all-payer hospital rate setting: a state commission sets hospital rates for every payer under a federal Medicare waiver instead of each plan negotiating separately.
Maryland’s Medicaid programme is Maryland Medicaid (HealthChoice). Practices with a meaningful Maryland Medicaid (HealthChoice) mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
What a prior authorization seat does in Maryland
Submitted before the date of service and chased through the payer's decision window.
An authorisation found after the visit is a write-off, not a denial to appeal. In Maryland the work is submitting ahead of scheduling and chasing the decision, against a payment clock that starts only once a clean claim lands.
- Authorizations submitted ahead of scheduling, not after
- Status chased rather than waited on
- Peer-to-peer reviews scheduled when required
- Clinical documentation gathered before submission
- Expiring authorizations flagged before they lapse
- Worked during Maryland business hours, not queued overnight
For the statute behind all of this — Maryland’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Maryland billing page.
Working Maryland hours
Maryland runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Maryland hours and nobody else’s.
What it costs in Maryland
$2,000
Per seat, per month, in US dollars — $24,000 a year for one full-time person, forty hours a week, on Maryland hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Maryland run $1,600 to $2,650; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Maryland
About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
Questions
Do you work with Maryland practices?
Yes. Maryland accounts are worked during Maryland office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Maryland?
Maryland is the only state with all-payer hospital rate setting: a state commission sets hospital rates for every payer under a federal Medicare waiver instead of each plan negotiating separately.
How long do we have to file a Maryland Medicaid (HealthChoice) claim?
12 months from the date of service, measured from the date of service. Medicare-related claims: 12 months from the date of service or 120 days from the Medicare remittance date, whichever is later. Past that date a claim is not late, it is unpayable, and no appeal recovers it. Source: COMAR 10.09.36.06 — Billing Time Limitations.
When does a Maryland payer have to pay a clean claim?
30 days after receipt of the claim (Md. Code, Insurance § 15-1005(c)). The statute sets no separate electronic vs. paper deadline. Unpaid clean claims accrue escalating monthly interest — 1.5% for days 31-60, 2% for days 61-120, 2.5% thereafter — paid automatically without the provider having to ask. A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does prior authorization cost in Maryland?
$2,000 per seat per month — $24,000 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Maryland queue?
Maryland is on Eastern time, 10 hours behind Rawalpindi. The shift here runs 7pm to 3am so your seat is at a desk for your full working day, shifting to 6pm to 2am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle Maryland Medicaid (HealthChoice) as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. Maryland Medicaid (HealthChoice) has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
Next step
One seat on your Maryland work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com