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Stream RCM offers medical billing services in Maryland for doctors and healthcare practices of all sizes. We convert your patient notes to accurate medical codes and send your claims and follow up until the claim gets paid. Denials, A/R and credentialing are covered too. Our team bills Medicare, Maryland Medicaid (including HealthChoice plans) and commercial insurance. Your reports show what’s been paid and what’s still open.
In a normal week, a Maryland front desk might check in patients with Medicare, Medicaid, marketplace plans and a few commercial insurers. Medicaid is the big one. About 1.47 million people had it in January 2026. HealthChoice covered 86 percent of them through nine different MCOs. What works for one plan may not work for the next because each one has its own portal, appeal process and prior authorization list. That means one wrong plan on file can hold up a claim for weeks.
HealthChoice Share
Expansion Adults
Automatic Renewals
A pediatric office’s billing is very different from that of a cardiology group. Cardiology depends on the right modifiers for imaging and procedures. Pediatrics runs on well-child visits and vaccine codes. We support over 50 specialties, and our coders know the CPT, ICD-10-CM and HCPCS rules for each one. We also track the prior auth and documentation needs that change from one payer to the next. Beyond the ten shown here, we bill for behavioral health, family practice, internal medicine, dermatology, physical therapy, wound care, anesthesiology and urgent care.
If you are comparing medical billing companies in Maryland, look at the numbers first. Ask for a clean claim rate, and ask who does the coding. Here’s what Stream RCM brings. These are our own figures, so put them next to yours and see how they compare.
Good medical billing and coding in Maryland starts long before a claim goes out. We take it one step at a time, from patient intake until the last payment posts. Select a stage below to see what happens there.
Patient Information
Insurance EligibilityClinical Coding
Complete Charge
Claim
Payment
Denial
A/R and PatientMost billing problems start at the front desk. One wrong letter in a name can get a claim rejected. So can an old address or a missing member ID. That’s why our team checks demographics, insurance cards and guarantor details before anything is billed. Medicaid patients get one more check: which HealthChoice MCO are they in right now? People do move between MCOs and fee-for-service coverage. Starting January 1, 2027, federal law also shortens retroactive Medicaid coverage, so an intake mistake will be harder to fix later.
A patient's coverage can change between one visit and the next. Last month's check doesn't count. Before services are billed, we confirm the plan is active and note the copay, deductible and any prior auth needs. For Maryland Medicaid, we run each patient through the state's Eligibility Verification System (EVS) for the actual date of service. In 2027, this gets more important when ACA expansion adults move from yearly renewals to six-month checks. If we spot a coverage lapse early, your staff can talk with the patient before the claim goes out.
Your provider writes the note. Our AAPC-certified coders turn it into the CPT, ICD-10-CM and HCPCS codes payers use. Every diagnosis has to back up the service on the claim, and we check that it does. NCCI edits are part of the review too, since some code pairs get bundled into one payment. Sometimes a note leaves room for doubt. We ask the provider. Guessing is how compliance problems start.
Busy days are when charges slip through. A supply, an injection or a second procedure gets done and documented, then never billed. We compare every visit note with the charges entered. Orthopedics, cardiology and GI need this most, since they often bill more than one procedure per visit. You also get a clear trail from each service to its claim. That trail helps a lot if a payer ever audits you.
In Maryland, the right destination depends on the patient’s coverage. For Medicare Part B, that’s Novitas Solutions, which handles Jurisdiction L. A HealthChoice patient’s claim is sent to whichever MCO they’re enrolled in. If the patient has fee-for-service Medicaid, we bill the state directly. Commercial plans are a different story, since each one sets its own rules. We scrub every claim for missing data and code conflicts before it leaves our hands. Then we watch the acceptance and rejection reports. Small problems get fixed while they’re still small.
Posting is where you see the gap between what you billed and what you actually got. From ERAs and paper EOBs, We record insurance payments, contractual adjustments and patient balances from ERAs and paper EOBs. Then we compare each payment with what your contract says. If a payer pays short, we catch it. By our numbers, 90 percent of claims get paid within 30 days, though some payers are slower than others. Clean posting also gives your front desk correct balances when patients call with questions.
No denial is random, and the same reason tends to come back. We sort each denial by cause: eligibility, prior auth, coding, documentation or a missed filing date. Fixable claims get corrected and resent. The rest get a written appeal with the right records attached. Then we look for patterns. If one MCO keeps denying the same code, we find out why and fix it at the source. In our results, denials drop by up to 75 percent, but your payers and specialty will shape your own numbers.
Unpaid claims lose value the longer they sit. We sort your A/R by age and amount, and claims near their filing limit come first. Maryland Medicaid gives you up to a year after the date of service for fee-for-service claims. MCOs and commercial plans often allow less time. Our team calls payers, checks status online and resubmits when needed. Across our clients, collections rise 40 to 50 percent from where they started.
In-house billing costs more than salaries. Add benefits, training and software, plus someone to cover when a biller is out sick. Outsourcing turns most of that into one fee based on what you collect. If you plan to outsource medical billing services in Maryland, that’s usually the part that matters most. We see clients save 40 to 50 percent on billing costs, though your number depends on practice size, specialty and payer mix.
| Billing Consideration | In-House Billing | Outsourced Stream RCM |
|---|---|---|
| Staffing Structure | Salaries, benefits, hiring, training and backup staff | A dedicated billing team and account manager |
| Claim Performance | Depends on staff skill and internal checks | Claims scrubbed for errors before they are sent |
| Denial Management | Staff look into and appeal denials when time allows | Denials sorted by cause, fixed and followed up |
| Operating Cost | Fixed payroll and software costs | Fee starts at 2.99 percent of monthly collections |
| Performance Visibility | Depends on internal reports | Real-time reports on claims, denials, payments and A/R |
Your billing, coding, denials, A/R and credentialing, all handled by one team.
We build each claim, check it, send it and track it. Small errors get fixed before they slow down payment.
Your notes become the right CPT, ICD-10-CM and HCPCS codes, with modifiers that fit your specialty's rules.
Every denial gets a reason. We correct the claim or appeal it, then stay on it until the payer answers.
Old balances don't get ignored. We call payers about open claims and show you exactly what's still owed.
We handle CAQH profiles, PECOS for Medicare, Maryland Medicaid enrollment in MPRIME and MCO credentialing, then track renewals so nothing lapses.
Maryland has 23 counties plus Baltimore City. Medicaid enrollment runs from about 5,000 people in Kent County to over 260,000 in Prince George’s. Where your patients live tells us which payers and checks matter most for your practice.
260,994 people were on Medicaid, more than any other county. Practices here need steady MCO checks on every visit.
The city had 249,281 Medicaid enrollees, and 63,163 of them qualified through expansion. Clean eligibility work keeps city practices paid on time.
227,769 Medicaid enrollees. From Towson to Dundalk, practices see patients across all nine HealthChoice MCOs.
209,161 Medicaid enrollees, in a county where many patients also carry commercial or marketplace plans. Mixed payer list needs careful claim routing.
107,200 residents had Medicaid. Around Annapolis, one practice can see Medicaid, Medicare and private plans in the same morning.
Medicaid covered 52,552 people here. Columbia and Ellicott City practices benefit from tight prior auth tracking.
Medicaid count: 50,920. In Bel Air and Aberdeen, regular coverage checks cut down on eligibility denials.
Frederick County counted 48,229 Medicaid enrollees. Growing practices here need billing that keeps pace with new patient volume.
48,186 people had Medicaid, 10,448 of them through expansion. Hagerstown practices benefit from regular checks on MCO assignment.
Just under 39,000 residents (38,959) were on Medicaid. Salisbury practices often bill several MCOs in the same week.
37,216 on Medicaid. In Waldorf and La Plata, correct MCO details at check-in save a lot of rework.
Cecil had 27,385 Medicaid enrollees. Practices in Elkton and North East get paid faster when claim data is right from the start.
25,392 people had Medicaid here. Westminster practices get the most out of clear A/R reports and steady follow-up.
Allegany's Medicaid count stood at 22,213. Cumberland practices need payer follow-up that doesn't fall behind.
22,566 Medicaid enrollees. For small practices in Princess Anne and Crisfield, checking coverage up front helps head off eligibility denials.
Numbers tell you more than promises do. The figures below come from Stream RCM performance across the practices we work with. They are not guaranteed results for every practice, since your specialty, payers and starting point all play a part.
We handle patient data review, eligibility checks, coding, charge entry, claim submission, payment posting, denials, A/R follow-up and reporting. We work with Medicare, Maryland Medicaid, HealthChoice MCOs and commercial plans.
Yes. We bill fee-for-service Medicaid and HealthChoice MCO claims for the plans your providers are enrolled with. That includes checking EVS, sending claims to the right plan and following up on denials and appeals.
Yes. We work inside your existing EHR or practice management system, including eClinicalWorks, AdvancedMD, Tebra (formerly Kareo) , athenahealth, NextGen and DrChrono. Setup needs depend on your system.
Since October 1, 2026, some lawfully present immigrants, such as refugees and asylees, are no longer eligible for Medicaid. From January 1, 2027, many ACA expansion adults will have to meet work or community engagement rules to keep coverage.
Stream RCM pricing starts at 2.99 percent of monthly collections. Your final rate depends on your specialty, claim volume and the services you need.
Ask for clean claim and denial rates, check that coders are certified and confirm they know HealthChoice MCOs. Clear pricing and regular reports are also good signs.
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