Welcome to Managed Care That's Easy to Manage
Everyone at MPC truly appreciates your commitment and support in managing the healthcare of our members. We will go Above & Beyond to answer your questions and make managed care that’s easier to manage.
If you have questions or need additional information, contact MPC Provider Services at 1-800-953-8854, Option 3, or reach out to your Provider Relations Representative.
NEW: 2024 MPC APPEAL SEARCH ABILITY VIDEO TUTORIAL
Follow these step-by-step video instructions showing you how to search, view, and monitor the progress of your appeals. A companion PDF guide is also available for download.
Watch the Video
Download the PDF Guide
ATTENTION: MPC PROVIDERS
Effective January 1, 2022, Maryland Physicians Care is offering an electronic claim appeal submission tool for Provider Appeals. This is solely for the submission of Provider Appeals. The link to MPC Web Claim Appeal Submission will direct you to the submission tool. As part of your submission, you will receive an e-mail communication back confirming receipt of your appeal.
MEDICAL MANAGEMENT
Scheduled Inpatient and Outpatient Prior Authorization
Fax: 1-800-953-8856
Notice of Admission
Fax: 1-800-385-4169
Concurrent Review / Clinical Information
Fax: 1-855-905-5939
Special Needs Coordinator
Fax: 1-844-284-7698
SPECIALTY SERVICES
High Tech Radiology Imaging National Imaging Associates (NIA)
Phone: 1-800-424-4836 | radmd.com
Non-Emergent Medical Transportation (NEMT)
Phone: 1-800-953-8854
Routine Vision Services – Superior Vision
Phone: 1-800-428-8789
Dental Services – Healthy Smiles Program (under 21 and pregnant women)
Phone: 1-855-934-9812
Pharmacy Services – Express Scripts
Phone: 1-800-753-2851
Fax: 1-877-251-5896
RxBIN: 610084
PROVIDER RELATIONS
MPC providers have designated Provider Relations Representatives based on the practice/group location. This specialist will be your primary contact with MPC and will keep you updated on any policy changes. To find your Provider Relations Representative, visit the territory contact list.
TRANSLATION SERVICES
Providers may contact MPC Provider Services at 1-800-953-8854, which will link to a translation service (telephonic only).
CLAIMS PAYMENT
Electronic Fund Transfer (EFT) and Electronic Remittance Advices (ERA) will move to InstaMed for dates of service on or after January 1, 2021
To register, visit instamed.com/eraeft or call 1-866-945-7990.
MANAGE CLAIMS
View claims and EOPs for free through MPC’s secure web portal.
Electronic Clearinghouse Availity
Payor ID – 76498
Phone: 1-800-Availity
Mail paper claims to:
Maryland Physicians Care
P.O. Box 21099
Eagan, MN 55121
AUTHORIZATION REQUESTS
Submit authorizations for free through MPC’s secure web portal.
Fax: 1-800-953-8856
Phone: 1-800-953-8854
Pre-Service appeals, services have not yet been rendered or appeals where the member is in a hospital/facility are considered MEMBER APPEALS. For all other appeals, specifically Post-Service appeals, where services have been rendered, are PROVIDER APPEALS. Please fax/mail to the appropriate number/address below and complete the appropriate form, where necessary.
MEMBER PRE-SERVICE APPEAL
MPC requires a formal written request to reconsider a medical decision. Medical records should be attached. For additional information, visit Member Complaints, Grievances and Appeals.
Member Pre-Service Appeal Form
Fax: 866-831-0790
Mail or fax form and documentation:
Maryland Physicians Care
Member Appeals
PO Box 893
Portland, ME 04104
Please note that member consent is required.
PROVIDER POST-SERVICES APPEALS
Appeals must be submitted within 90 days of the claim remittance advice, or it will be denied for timely submission.
NEW – Click to submit your Claim Appeals electronically. MPC has created an efficient way to submit Provider Appeals. As an alternative you can mail or fax these as follows:
Fax: 1-833-656-0648
Mail form and medical records for claims to:
Maryland Physicians Care
PO Box 1104
Portland, ME 04104
PROVIDER ADDITION/DELETION REQUEST FORM
Download and complete the Request Form PDF and fax to 1-866-333-8024.
Frequently Asked Questions
If you are interested in a contract with MPC, please submit a non-binding letter of intent to the MPC Contracting Department.
Mail
Maryland Physicians Care
Attn: Contracting Department
1201 Winterson Road, 4th Floor
Linthicum Heights, MD 21090
E-mail
mpcprovidercontracts@mci-mcmi.com
Fax
410-734-5351
For additional information on the criteria we use to help make contracting decisions, visit Become A Provider.
Download Current Provider Manual (PDF)
For information on how to contact MPC or submit a claim refer to our Quick Reference Guide.
View the Preferred Drug List (PDF)
If you need further assistance call Provider Relations at 800-953-8854.
Log into the secure provider portal, and search under Eligibility and PCP Panel Roster for a current member panel listing, or contact your Provider Relations Representative for assistance.
Medication Request Through the Pharmacy Benefit
Print the applicable prior authorization forms for Outpatient Pharmacy Medications Processes and fax to 1-877-251-5896 or contact ESI prior authorization department at 1-800-753-2851.
Medication Request Through the Medical Benefit
Print the applicable New Prior-Authorization Form (PDF) (required form as of 4/1/21) and fax to 1-800-953-8856 or contact Pharmacy prior authorization department at 1-800-953-8854.
Pre-Service Request
Print the applicable prior authorization form and fax to 1-800-953-8856 or contact the prior authorization department at 1-800-953-8854.
Notification of Inpatient Admission
Print the applicable prior authorization form and fax to 1-800-953-8856 or contact the prior authorization department at 1-800-953-8854.
Contact the State of Maryland’s Eligibility Verification System (EVS) at 1-866-710-1447 or contact Member Services at 1-800-953-8854 to verify enrollment.
Please refer to the HealthChoice Benefit Summary page for a brief description of covered benefits. For a complete description of benefits, please refer to the Member Handbook.
Visit the Maryland Health Connection website or call Maryland Health Connection at 1-855-642-8572 for additional information.
