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Appeals

Maryland Physicians Care has a process regarding provider appeals as a request for a review of an action-related to claims denials. Appeals for service denials, reductions or terminations are considered member appeals and follow the MCO member appeal process.

Maryland Physicians Care requires all provider appeals to be submitted in writing to:

Medicaid Claims Reconsideration Department
P.O. Box 5080
Farmington, MO 63640-5080

  • Providers have 90 business days to file an appeal from the date of claim denial. Maryland Physicians Care acknowledges provider written appeals within five business days of its receipt.
  • Providers are allowed 30 days from the date of Maryland Physicians Care’s appeal determination to file one subsequent level of appeal for consideration. Second level appeals must include additional information or documentation for consideration. 
  • Maryland Physicians Care resolves denial of payment appeals (including a second level appeal within 90 business days of receipt of the initial appeal by Maryland Physicians Care). 
  • Previously denied claims are paid within 30 days of the appeal decision when a claim denial is overturned. 

We will not take any punitive action against a provider for utilizing our provider complaint process.