Prior Authorization
Prior authorization is one way Maryland Physicians Care monitors the medical necessity and cost effectiveness of the services our members receive. Participating and nonparticipating health professionals, hospitals and other providers are required to comply with MPC's prior authorization policies and procedures. Noncompliance may result in delay or denial of reimbursement.
- All elective hospital admissions require prior authorization.
- To ensure a timely response to your request, submit all prior authorization requests at least 7 days in advance.
- Nonparticipating providers must obtain prior authorization before rendering any service other than emergency and self-referral services.
- Services that require prior authorization will be reimbursed only if prior authorization has been obtained.
- Prior authorization requests can be submitted via the web (outpatient services only), phone and fax.
- New authorization requests for oncology and radiation treatment should go through eviti® at www.eviti.com.
- In conjunction with the member handbook to determine benefits, registered providers should utilize the MPC Prior Authorization Lookup Tool to determine prior authorization requirements.
- All laboratory and radiology services should be performed in a free-standing facility when clinically appropriate. Exceptions to the rule are included in the laboratory and radiology change announcements attached below.
You can reach MPC’s Prior Authorization Department at 1-800-953-8854.
ASC Change Announcement
Radiology Change Announcement
Laboratory Change Announcement
eviti® Announcement