Referring a client to a Psychiatric Rehabilitation Program (PRP) should take a few minutes, and a good PRP referral checklist keeps it that way. In practice, one missing detail, such as a group NPI or a lapsed Medicaid enrollment, can delay services for weeks. Since January 1, 2026, Maryland Medicaid denies PRP claims when the referring provider is not actively enrolled, so getting the referral right the first time matters more than ever.
This guide covers who can refer, what to have ready, what happens after you submit, and how to keep services going once your client is enrolled.
Who Can Refer to PRP in Maryland
Under Maryland Medicaid rules (COMAR 10.09.59.05, explained in Provider Transmittal PT 13-26), the referring provider must:
- Be a licensed mental health professional
- Currently provide inpatient, residential treatment center, or outpatient mental health services to the individual
- Be enrolled with Maryland Medicaid as an individual practitioner, with active status on the date of service
- Help the individual make an informed choice among PRP providers
Two details trip up many referrals. First, the NPI on the referral must be your individual NPI, not a group or facility number. Second, clinicians who do not bill Maryland Medicaid can still refer by enrolling as an Ordering, Referring, and Prescribing (ORP) provider through ePREP.
At Advocate, we also accept referrals from graduate-level clinicians (LMSW, LGPC, LGMFT, LGADC, and LGPAT) when their licensed supervisor is listed on the referral.
Your PRP Referral Checklist
Before you submit a referral, confirm each item below:
- Age and location: the client is 18 or older and lives in a county we serve: Anne Arundel County, Baltimore County, Baltimore City, Howard County, or Prince George’s County.
- Coverage: the client has active Maryland Medicaid, or may qualify as uninsured through the state’s public behavioral health system.
- Diagnosis: a serious and persistent mental illness that meets Maryland’s priority population criteria.
- Functional need: a short description of how the illness affects daily functioning, such as self-care, housing stability, or community participation.
- Treatment relationship: you are actively treating the client.
- Your credentials: your individual NPI and active Maryland Medicaid enrollment, plus your supervisor’s information if you hold a graduate-level license.
- Client awareness: the client knows about the referral, wants community-based support, and has been offered a choice of PRP providers.
- Contact details: a current phone number for the client, and an alternate contact if possible.
If you are unsure whether a client qualifies, our eligibility page explains the criteria in more detail. For help deciding whether PRP is the right next step, see When Is It Time to Refer to PRP?
What Happens After You Refer to Advocate
We built our referral process around one principle: you should never have to wonder what happened to your referral.
- We respond quickly. We aim to respond to every referral within 2 hours. Referrals received after 4:00 PM, on weekends, or on holidays receive a response by 11:00 AM the next business day.
- We review it carefully. Our intake specialist verifies insurance, the diagnosis, and your referral details. If anything is missing, we call you rather than letting it sit.
- We reach out to your client. We call your client to schedule an intake and assessment, typically within 24 to 72 hours.
- We tell you the outcome. You hear back whether the appointment was scheduled or whether we were unable to reach your client.
- We close the loop. After the intake, we let you know whether it was kept and the admission decision. If your client is admitted, you receive the name and contact information of their assigned Rehabilitation Specialist and Case Worker.
Keeping Services Going: The 6-Month Concurrent Referral
Maryland requires a signed referral from the individual’s treating outpatient mental health provider at least every 6 months for PRP services to continue. We need this concurrent referral before we can request continued authorization from Carelon Behavioral Health of Maryland, so a late form can interrupt services.
Our secure Concurrent Referral form takes about 3 minutes. Have these ready:
- The date of your most recent visit with the client (within the last 60 days)
- The current diagnosis and a brief clinical rationale
- Your individual NPI and Maryland Medicaid enrollment status
Common Reasons PRP Referrals Stall
- A group or facility NPI instead of the referring clinician’s individual NPI
- A referring provider who is not enrolled with Maryland Medicaid, or whose enrollment has lapsed
- No current treatment relationship between the referring provider and the client
- An outdated phone number for the client
- A graduate-level clinician’s referral without a licensed supervisor listed
You can check a practitioner’s Medicaid enrollment status through Maryland Medicaid’s Provider Verification System before submitting.
Ready to Refer?
Submit a referral online. The form is built for licensed mental health professionals and their authorized staff. Questions before you refer? Call our admissions team at (866) 277-2080, extension 2, Monday through Friday, 8:00 AM to 6:00 PM.