Maryland says Carelon Behavioral Health will replace Optum Maryland as the public behavioral health system's administrative service organization on January 1, 2025.
Maryland announces ASO vendor change
The Maryland Department of Health’s Maryland Medical Assistance Program announced that Carelon Behavioral Health will become the Administrative Service Organization for Maryland’s Public Behavioral Health System effective January 1, 2025. The Department said Carelon will replace Optum Maryland in that role.
According to the Maryland Department of Health transmittal, the Public Behavioral Health System includes Medicaid/HealthChoice behavioral health benefits. The ASO manages functions including authorizations, claims, provider management, and compliance for participants in the public behavioral health system.
Contract and transition schedule
The Maryland Department of Health said the Carelon contract award began March 1, 2024. The Department described the period before the January 2025 change as a 10-month implementation and transition period during the final year of the prior Optum Maryland contract.
The transmittal states that the contract’s base period runs for five years, from January 1, 2025, through December 31, 2029. It also includes one two-year renewal option, which could extend the award through December 31, 2031.
Provider systems, authorizations and claims
The Maryland Department of Health said it is working with Optum Maryland to support the transition. According to the transmittal, that work includes transferring authorizations, claims payment processing, participant history, and other information and materials from Optum Maryland to Carelon.
The Department said Carelon will carry out outreach and provider training as it opens its Maryland operations and introduces its new system. The transmittal cites Carelon’s prior work performing similar ASO functions in Maryland and other states, including provider management and maintenance, participant education, authorization and utilization management, provider assistance and communication, provider audits and training, claims processing and payment, data analytics, and reporting.
Relevance for behavioral health services
According to the Maryland Department of Health, the ASO vendor change affects the administrative systems used for authorizations, claims, provider management, and compliance in the public behavioral health system. The transmittal says this makes the change relevant to behavioral health providers, including providers delivering services such as TMS therapy under the public system, because of how providers are credentialed, authorized, and reimbursed statewide.
What this means for Maryland patients
Patients seeking treatment locally may encounter administrative changes as the public behavioral health system transitions to Carelon; the directory lists 100 published clinics in Maryland.
This is general information, not medical advice.
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