The referring practitioner’s NPI, since January 1, 2026
Maryland Medicaid transmittal PT 12-26, dated August 21, 2025, applies a federal rule (42 CFR 455.440) to Psychiatric Rehabilitation Programs. For dates of service from January 1, 2026, a PRP claim must carry, in the Referring Provider field (Field 17b), the NPI of an individual practitioner who is actively enrolled with Maryland Medicaid on the date of service. A group or facility NPI is not reimbursable, and claims that miss these criteria are denied.
The referral itself must come from a licensed mental health professional enrolled as a Medicaid provider (COMAR 10.09.59), and the transmittal makes the PRP responsible for checking that enrollment, with the state’s Provider Verification System.
Capture the referral once, at admission
The referring practitioner is known the day a participant is admitted. We build your admission or referral form with the practitioner’s name and individual NPI as required fields: the form cannot be sent without them, and the answers land in your Google Sheet next to the participant’s name, for whoever prepares your claims.
Yanforms does not check an NPI against Medicaid enrollment. That check stays with your team, in the Provider Verification System, as the transmittal asks.
A visit record that proves the visit
We build your visit record for the places PRP work happens: the GPS location is taken at the moment of signing, a photo shows the participant with the staff member, the participant and the staff member each sign, and the time of signature closes the visit. If you make the location required, a visit cannot be signed without it.
With no signal, the visit waits on the phone and sends itself once the connection is back. Each visit becomes one signed PDF, with the photo and both signatures inside, plus one row in your Google Sheet.
Why proof matters for PRPs now
Since July 1, 2024, Maryland Medicaid has not accepted new enrollments of PRPs, partial hospitalization programs and intensive outpatient programs in ten jurisdictions, including Baltimore City and Baltimore County. The state has renewed the pause every six months, as part of its effort to assess the provider landscape and to identify and mitigate potential fraud, waste and abuse (MDH, PT 35-26), and extended it again in June 2026 (WYPR). Programs already enrolled keep operating.
In December 2025, a woman who ran two Maryland companies billing PRP services was sentenced to 10 years in prison for more than $3.6 million in Medicaid fraud, built on forged signatures and fake patient records (Maryland Attorney General). A record signed on the spot by the participant and the staff member, with its place and time, is the opposite of that.