If you are enrolled in Medicaid, you must renew once a year or you will lose your coverage.

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Billing and Claims

For instructions on how to submit a claim with Maryland Physicians Care, please see our Claims Submission Guide (PDF).

Billing

Claims will be considered for reimbursement only if MPC appropriately authorizes them, are a covered benefit, and the enrollee is eligible at the time of service.

If prior authorization is required, the prior authorization number must be entered on the appropriate billing form. However, authorizations in themselves are not guarantees of payment.

Sudden and Serious

The ER Sudden and Serious List (PDF) includes the ICD-10 codes designating an emergency room visit requiring immediate medical attention. The ER Sudden and Serious List will automatically adjudicate the hospital claims.

Claims/Encounter Data Reporting Requirements

Providers shall utilize the most current diagnostic and procedure coding guidelines, including but not limited to International Classification of Diseases (ICD), American Medical Association Current Procedural Terminology (AMA CPT), Health Care Financing Administration Common Procedural Coding System (HCPCS), Diagnostic Statistical Manual (DSM), Current Dental Terminology (CDT), and Uniform Billing Data Elements (UB-04) Specification Manual.

Claim Inquires

Providers may contact MPC’s Provider Services to check the status of claims submitted for reimbursement, clarify any denials or other claim processing actions. Provider Services can be reached at 1-800-953-8854 and then follow the prompts. Registered network providers may also perform claims inquiries through the employment of MPC’s HIPAA-compliant web portal, My MPC Source.

Timely Filing Limitations

Providers must submit electronic or paper claims to MPC for reimbursement within one hundred eighty (180) days from the service date. For a claim on a CMS 1500 claim form, one hundred eighty (180) days are counted from the day the service was performed. For a claim on a UB 04 claim form, one hundred eighty (180) days are counted from the date of discharge for the hospital or nursing homestay. Claims that are not initially received within one hundred eighty (180) days of the service date may be denied for payment.

After MPC has adjudicated a claim, you will receive a Remittance Advice with the reimbursement, which will provide details about the submitted claim and its status.

Ways to Manage and Submit Claims

Web Portal

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 Data Interchange (EDI)

Electronic Clearinghouse Emdeon
Payor ID = 76498
Phone: 1-866-506-2830

Please contact your Provider Relations representative for further information on electronic claims or a list of approved EDI vendors.

Mail paper claims to:

Maryland Physicians Care

P.O. Box 21099
Eagan, MN 55121

Until 6/13/21, pre-2021 dates of service (DOS) paper claims can be mailed to:
Maryland Physicians Care

P.O. Box 5080
Farmington, MO 63640-5080

Effective 6/14/2021, all claims regardless of DOS should be sent to Eagan, MN. Claims sent to any other address will be returned.

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.

Important Claims Processing Update

Effective 6/14/2021, all paper claims regardless of DOS should be sent to:
Maryland Physicians Care
P.O. Box 21099
Eagan, MN 55121