Forms

Forms that make doing business with us easier

Whether you need to make a referral, request prior authorization for a treatment or more, filling out the necessary forms will help us respond to your needs quickly and efficiently. Just click on the appropriate form name below to get started.  Please contact Provider Relations at 1-800-953-8854 (option 2), then follow the prompts to the Provider Relations department. Or email providers@marylandphysicianscare.com with any questions or to check enrollment status.

ERA and EFT enrollment forms have changed.  Enroll electronically with PaySpan by visiting our Secure Web Portal.  For assistance registering please call PaySpan's Provider Support at 877-331-7154. option 1, Monday trhough Friday, 8:00 am to 8:00 pm ET or email at providersupport@payspanhealth.com.

General Provider Forms