OMHCs May Not Bill Place of Service 22: 30-Day Window to Correct Paid Claims

This is a reminder of existing policy, not a new one. COMAR 10.09.59.04B(4) requires an OMHC participating in Maryland Medicaid to comply with COMAR 10.63.03.05, which requires services in a community-based setting, and COMAR 10.63.01.02B(14) defines community-based as a setting not located in a hospital. CMS defines POS 22 as an on-campus outpatient hospital setting. An OMHC claim with POS 22 therefore describes a service that is not reimbursable under the OMHC benefit.

Carelon has identified OMHC claims that were submitted and paid with POS 22 and set a 30 calendar day window from the August 17 alert for corrective action, which runs to about September 16, 2026.

What to do

• Pull every OMHC claim with POS 22 from the review period.
• If the service was delivered in an allowable non-hospital setting and POS 22 was a coding error, submit a corrected claim with the accurate place of service, reference the original claim with the correct claim-frequency indicator, and keep documentation of the actual service location.
• If the service was delivered in a hospital, submit a voided claim or return the payment under Carelon's claims-adjustment procedures. Do not resubmit under a different POS.
• Stop submitting OMHC claims with POS 22 going forward.