Provider Forms
Questions? Contact Provider Relations at 1-800-953-8854, then follow the prompts to the Provider Relations department or email MPCproviders@marylandphysicianscare.com.
For claims payment, MPC uses InstaMed to provide free Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA). To register, call 1-866-945-7990 or visit instamed.com/eraeft.
Forms
Enteral/Nutritional Supplement Form
Health Education Presentations
Local Health Services Form and Instructions (PDF)
Maryland Healthy Kids Program Pediatric Visit Sheets (Encounter Forms)
Maryland Healthy Kids/EPSDT Provider Application for Certification (PDF)
Maryland Healthy Kids Provider Forms
Maryland Uniform Consultation Referral Form (PDF)
Maryland Uniform Credentialing Form (PDF)
New Prior-Authorization Form (PDF) – Required Form as of 4/1/21
Newborn Notification Form (PDF)
Pharmacy Prior Authorization Forms
Primary Care Physician Change Form (PDF)
Provider Verification Form (PDF)
Remote Patient Monitoring (RPM) Preauthorization
Sterilization Consent Form (PDF)