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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.

ATTENTION: MPC PROVIDERS
Effective January 1, 2021, several phone and fax numbers were updated in the transition with our new partner, Evolent Health. Please note that most pharmacy prior authorization request forms need to be faxed to ESI at 1-877-251-5896 and prior authorization requests for Hepatitis C medications need to be faxed to MPC. The link to MPC Approved Drug Benefits will direct you to the appropriate forms and provide the necessary submission details for completing pharmacy prior authorization requests.

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: 1-877-535-0591

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 – DentaQuest (21 and older)
Phone: 1-800-685-1150

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.

View, submit, and adjust claims for service dates before 1/1/21 here

Electronic Clearinghouse Emdeon

Payor ID – 76498
Phone: 1-866-506-2830

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

SUBMIT APPEALS

Appeals must be submitted within 90 days of the claim remittance advice, or it will be denied for timely submission.

Complete Appeal Form

Fax: 1-833-656-0648

Mail form and medical records for claims to:

Maryland Physicians Care
PO Box 1104
Portland, ME 04104

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.

Fax: 866-861-0790

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 ADDITION/DELETION REQUEST FORM

Download and complete the Request Form PDF and fax to 1-866-333-8024.

Frequently Asked Questions

How can I become part of the Maryland Physicians Care Provider Network?

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.

How do I obtain a copy of the current provider manual, directory, and/or preferred drug list?

Download Current Provider Manual (PDF)

For information on how to contact MPC or submit a claim refer to our Quick Reference Guide.

Find Network Providers 

View the Preferred Drug List (PDF)

If you need further assistance call Provider Relations at 800-953-8854.

How do I obtain pharmacy authorizations from Maryland Physicians Care?

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.

How do I obtain UM Authorizations from Maryland Physicians Care?

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.

How do I verify enrollment of a patient?

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.

What are services covered by Maryland Physicians Care?

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.

How can HealthChoice recipients join Maryland Physicians Care?

Visit the Maryland Health Connection website or call Maryland Health Connection at 1-855-642-8572 for additional information.

Download the Quick Reference Guide for MPC Providers

Download the PDF

Contact MPC

Know The Facts About Coronavirus (COVID-19)

Symptoms are flu-like, including: fever, coughing, and shortness of breath.
If you think you might have been exposed, contact your doctor immediately. You can also have a video visit with a doctor using the MyVirtualMPC app.
It is important to do everything you can to protect yourself from COVID-19.