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 non-emergency elective hospital admissions require prior authorization.
- All outpatient hospital or facility-based surgical services require prior authorization.
- All elective inpatient or outpatient surgical request must be received for review at least seven working days before the service.
- Nonparticipating providers must obtain prior authorization before rendering any service other than emergency services.
- Participating providers must obtain prior authorization before rendering any service that is not exempt from prior authorization requirements.
- Services that require prior authorization will be reimbursed only if prior authorization has been obtained.
You can reach MPC’s Prior Authorization Department at 1-800-953-8854.
To learn more about prior authorization, download the Provider Manual.
What's New? - eviti®