Maryland Physicians Care & American Association of Healthcare Administrative Management June 21,...
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Maryland Physicians Care & American Association of Healthcare Administrative Management June 21, 2013
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Maryland Physicians Care
&
American Association of Healthcare
Administrative Management
June 21, 2013
Who We Are
Maryland Physicians Care (“MPC”) is a
Maryland Medicaid MCO owned by:
• Western Maryland Health System
• Meritus Health
• Maryland General Health System
• St. Agnes HealthCare
My MPC SourceHIPAA Compliant Website
Prior Authorization Search Tool
www.MarylandPhysiciansCare.com
The following information can be found on our website:
•Various Forms
•Provider Manual
•Current Drug Formulary
•Search the directory of participating providers
•Access to our Secure HIPAA Compliant Website
Member Eligibility Member eligibility can be checked several ways:
1. Call EVS @ 866-710-14472. Log onto EVS at:
https://encrypt.emdhealthchoice.org/emedicaid/_Portal/provWelcome.jsp
3. Log on to MPC’s Secure HIPAA compliant web portal at: https://MarylandPhysiciansCare.abovehealth.com
Claims Tips• Fill out claim form completely including NPI #• Timely filing limit for original submissions is 180
days from the date of service• Send claim to proper address:
Maryland Physicians CareAttn:Claims
PO Box 61778Phoenix, AZ 85082-1778
Prior Auth TipsProvide the following:
•Member information•Clinical note/explanation of medical necessity•Diagnosis and procedure codes•Date(s) of Service•When faxing use a cover sheet with correct phone & fax numbers for your practice
•Fax to MPC at 800-953-8856•For unscheduled admits fax to: 800-385-4169
Contact InformationProvider Relations• 1-800-953-8854 option 2, option 4
Prior Authorization • Monday – Friday 8:00am – 5:00pm• 1-800-953-8854, option 2, option 2 • 1-800-953-8856 (fax) • Secure HIPAA Compliant Website Link:
https://MarylandPhysiciansCare.abovehealth.com/
Contact Information
Claims Inquiry • 1-800-953-8854 option 2, option 3 • Secure HIPAA Compliant Website Link:
https://MarylandPhysiciansCare.abovehealth.com/
Appeals Inquiry • 1-800-953-8854 option 2, option 7 • Fax: 1-866-831-0790• Email: [email protected]• Basic appeals status should be checked by calling
the claims inquiry number listed above
Contact Information Claims Resubmission Address:
Maryland Physicians CareAttn: Claims Resubmission
P.O. Box 61778 Phoenix, AZ 85082-1778
Appeals Address:Maryland Physicians Care
Attn: Appeals509 Progress Dr.
Linthicum, MD 21090
Contact Information
Special Needs Coordinator for Case Management Services• 1-800-953-8854 option 2, option 6
HEDIS Coordinator• Roger Yates• 410-401-9493 – Direct line
Questions?
