To configure Maryland Medicaid ABA fee-schedule and BHASO controls, use the ABA fee schedule linked by the state program and the current provider manual, then route claims through the named behavioral-health administrator. Match provider eligibility, code, unit, service date, authorization, documentation, claim receiver, remittance, and deposit. Keep Maryland's general professional schedule apart from the ABA-specific schedule and route.

Editorial approval scope: The team checked current source fidelity, scope boundaries, dates, arithmetic, reader usefulness, practical workflow, and general-information limitations.

Define one Maryland rate configuration

Senara creates one versioned row for payer, product, program, code, modifier, unit, provider type, setting, service-date period, source, contract, billed charge, expected allowance, authorization, claim route, remittance, and cash. A change to a controlling field creates a new row. Earlier services retain the source and calculation used for their dates.

Read the current Maryland Medicaid ABA authority

Maryland's ABA page links the provider manual and ABA fee schedule and names Carelon as program administrator. The ABA manual says providers bill the BHASO and includes the program fee schedule. Senara treats that program-specific source as the rate authority for this workflow.

Separate state and managed-care sources

Maryland's 2026 professional fee page states that its maximum FFS rates do not apply to HealthChoice MCO members. General Provider Transmittal 121 describes the new real-time schedule site. Senara uses those sources as routing controls and avoids importing unrelated professional rows into the ABA register.

Normalize the source without losing evidence

Senara records publisher, title, URL or controlled contract reference, file name, revision, checked date, publication date, effective start and end, code, unit, provider, modifier, setting, amount type, scope, supersession, and open question. The operational row retains the source's display text and a stable reference to the original artifact. Confidential contract details stay role limited.

Give every amount a clear meaning

Fee-schedule maximum, provider-contract rate, billed charge, expected allowed amount, adjudicated allowed amount, adjustment, remittance, deposited cash, recoupment, refund, and realized margin answer different questions. Senara labels the amount type and governing source. A number copied from a portal or prior payment enters the register as dated evidence with a defined purpose.

Gate scheduling and claim release

Senara requires the current member route, effective rate source, covered code and unit, eligible provider, setting, modifier, authorization, contract when applicable, billed charge, expected-allowance calculation, claim receiver, and reconciliation rule. A missing fact creates a hold with its source, owner, age, and next action. Clinical recommendation, coverage, authorization, rate expectation, adjudication, and payment retain separate owners.

Verify code, unit, provider, and setting

Senara confirms whether the row pays per 15 minutes, hour, event, day, or another defined unit. The row also names provider level, required team, supervision configuration, modifier, place of service, and setting. Supported units come from the completed record and the applicable coding source. Routine administrative time enters a claim only when a current covered rule supports it.

Apply the service-date version

Senara selects the source effective when the service occurred and records any explicit retroactive direction. Publication, revision, effective, implementation, and service dates may differ. Archived versions remain available for corrections, appeals, audits, and recoupment review. A newly downloaded file changes future configuration only after its scope and effective period are clear.

Calculate expected allowance transparently

Senara shows supported units, applicable amount, modifier or contract adjustment, lower-of rule, multiple-procedure rule, rounding method, and arithmetic when each applies. Every input has a source. The calculation supports claim review and forecasting while leaving coverage, medical necessity, clean-claim status, adjudication, collection timing, and final payment to their governing processes.

Keep authorization apart from rate

An authorization may identify service, provider, setting, dates, and units while leaving rate and payment open. Senara compares authorization facts with the delivered record and rate configuration before release. A fee schedule may display a code that is unavailable for the member, provider, diagnosis, setting, service date, or delivery route. Each mismatch has its own hold reason.

Use rates in forecasts with declared assumptions

Senara models revenue from expected allowed amounts and explicit assumptions for payer mix, authorization, attendance, staffing, denial, collection lag, recoupment, and vacancy. Every scenario states whether it uses charges, scheduled value, expected allowance, adjudicated amount, or cash. The result remains a planning estimate tied to the stated volume, contract, rate version, and collection window.

Reconcile claim, remittance, and cash

Senara connects the original claim and every replacement, void, adjustment, appeal, remittance, deposit, debit, recoupment, refund, and member balance. A variance receives a reason, owner, evidence, due date, and disposition. Partial payments and zero-dollar remittances stay open until staff understand the claim state and financial effect. Deposits are matched to remittance detail before closure.

Work through Senara's fictional cohort

Senara locks 18 fictional records at the review date. 10 initially contain the current rate source, service-date row, code, unit, provider, route, authorization, expected calculation, claim receiver, and remittance map. Exceptions include one general professional row, two provider-eligibility errors, one wrong unit, one expired authorization, one wrong receiver, one rejected claim, and one unmatched deposit. Six are repaired and two remain on accountable hold. The cohort stays fixed while staff correct evidence.

Calculate Senara's measures

Maryland rate readiness is 10 of 18, or 55.6%. Records reaching release or accountable hold are 16 of 18, or 88.9%. Also report first-transmission rejects, adjudicated denials, same-source allowed variance, aged holds, unmatched cash, and recoupments. Preserve counts beside percentages and keep every pending record in its declared denominator.

Control the main Maryland failure mode

Senara treats a familiar code or amount as a prompt to verify, rather than as sufficient release evidence. State files, plan contracts, bulletins, portals, and remittances can update on different dates and serve different roles. The register names the controlling source for the member, route, service, provider, and date while preserving conflicting evidence for research and appeal.

Test Senara's controls

Senara tests an archived rate, a later rate, an incorrect unit, an ineligible provider, a missing modifier, an expired authorization, the wrong plan, a pre-adjudication rejection, a partial payment, a recoupment, and unmatched cash. Each test records starting facts, expected action, observed artifact, financial effect, correction, retest, owner, and disposition.

Run independent acceptance

Senara gives an independent reviewer the locked cohort, sources, contracts, records, authorizations, claims, acknowledgments, remittances, deposits, calculations, holds, and change log. The reviewer reproduces one allowance and one hold from original evidence. A changed denominator, hidden failure, unsupported rate row, unexplained difference, or missing service-date source fails acceptance and returns only the affected item for repair.

Maintain the Maryland ABA fee-schedule and BHASO payment register

Senara checks sources monthly and after code, rate, unit, provider, modifier, setting, authorization, contract, plan, manual, portal, bulletin, remittance, or contact changes. Each row retains owner, scope, effective and checked dates, supersession, and next review. This Maryland page remains draft and noindex until the named state-program, contracting, finance, revenue-cycle, and legal reviews finish.

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