Maryland medical assistance early and periodic - MMA - Home - mmcp dhmh maryland 2025

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  1. Click ‘Get Form’ to open the Maryland Medical Assistance Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program form in the editor.
  2. Begin by filling out the patient information section. Enter the Medicaid number, name, date of birth, sex, and contact details accurately.
  3. In the preauthorization general information section, provide your provider number and name along with the request date.
  4. Complete the additional preauthorization information by entering details about the prescribing audiologist including their provider number and contact information.
  5. For each service requested, fill in the description of service, procedure code, units required, and dates of service in the line item information section.
  6. Review all entered information for accuracy before submitting. Ensure that all necessary documentation is attached as required.

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Get help with Medicaid Call 1-855-642-8572. You can also visit a local health department, department of social services or a navigator near you. Pregnant women are encouraged to apply at local health departments. Call the Medicaid helpline for pregnant women at 1-800-456-8900 for information.
Medicaid, also called Medical Assistance (MA) pays the medical bills of needy and low-income individuals. It is administered by the State and pays medical bills with Federal and State funds. You may apply online at () or in person at one of DHSs 24 local departments of social services.
MCHP Premium program provides full health benefits to children up to age 18 and pregnant women who meet certain income guidelines even though they do not meet the MCHP income guidelines. MCHP and MCHP Premium enrollees obtain care from a variety of Managed Care Organizations through the Maryland HealthChoice Program.
The Maryland Childrens Health Program (MCHP) provides free coverage to eligible uninsured children whose family earns too much money to get Medicaid, but not enough to afford private health insurance. Your child may be eligible for Medicaid or MCHP even if you are not.
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