ISSUE 1 / SPRING 2024
HELP YOUR PATIENTS KEEP THEIR MEDICAID COVERAGE WITH MPC!
Maryland Medicaid requires members to renew their coverage.
Medicaid renewals will not be automatic this year. Your patients must renew their coverage with Maryland Health Connection this year to keep their health insurance benefits. Patients can renew their insurance by:
- GOING ONLINE to Maryland’s Health Connection at https://marylandhealthconnection.gov/checkin
- CALLING Maryland’s Health Connection’s Customer Service at 855-642-8572
- VISITING MPC’s website at mpcMedicaid.com/renew-membership
REMIND your patients to take these very important steps to keep their MPC coverage.
MPC is offering assistance to members trying to renew!
- Live call center assistance is available by calling Customer Service at 800-953-8854.
- Live in-person assistance is provided at local community events. For upcoming events, visit MPC Redetermination Events 2024.
For more information on assisting your patients, please visit the MDH website at https://health.maryland.gov/mmcp/Pages/home.aspx.
Newborn Enrollment Reminder
Newborns are enrolled in the MCO under the mother’s Medicaid ID number on the date of delivery. The MCO cannot be changed for 90 days. If you are treating a newborn who has not been issued a Medicaid ID number or does not have a Maryland Physicians Care (MPC) ID card, please contact MPC’s Newborn Coordinator (NC) for assistance at 1.800.853.8854.
The NC serves as the point of contact for providers and members with questions and/or concerns regarding eligibility and provision of health care services provided to the newborn within the first 60 days of life. The NC coordinates the authorization of in-network care and out-of-network care. In addition, they facilitate the resolution of claims for services provided to newborns and/or direct a provider to the appropriate claims contact for assistance.
For more information on the Newborn Coordinator’s Roles and Responsibilities, please visit MCO Newborn Coordinator (maryland.gov).
It’s That Time of Year Again: Maryland Healthy Kids Program/EPSDT Review
The Maryland Department of Health (MDH) conducts an Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program medical record review yearly for compliance with the American Academy of Pediatrics Periodicity Schedule. EPSDT services allow for early identification and treatment of health problems before becoming medically complex and costly.
MDH’s external quality review vendor—Qlarant—will conduct the review. MPC encourages, and MDH requires, that all providers participate and fully cooperate by:
- Responding timely to record requests.
- Ensuring all faxed or mailed-in medical records are complete and include lab and immunization records.
- Scheduling onsite reviews promptly upon request.
The Maryland Healthy Kids Program is developed by MDH in conjunction with other state departments. Additional Healthy Kids Program information can be found on the MDH website here https://health.maryland.gov/mmcp/epsdt/pages/home.aspx
MPC Correct Coding Corner
- Reminder: Providers must bill for services to receive reimbursement following MPC’s claims submission guidelines as indicated in MPC’s provider manual and quick reference guide.
- Urgent Care Facilities: Cannot bill for new patient E&M if the patient has been seen within the last 3 years.
- Credentialing: Participating practitioners need to complete credentialing successfully. Providers joining a participating group must have a completed application on file. Failure to submit completed credentialing documents will cause claims to be processed as non-participating.
- Claims Denials: MPC has seen an increase in claim denials due to inactive ePREP. Please ensure that your ePREP status is kept active.
- Additional Insurance: When members have other insurance as primary, please forward a copy of the other insurance company’s explanation of payment with your claim.
- Telehealth: Medicaid members continue to have benefits for telehealth visits.
Provider Claim Appeals
Providers must appeal claims disputes following Maryland Physicians Care’s provider claim appeal process, exhausting all levels of appeal as appropriate unless exclusively mutually agreed upon in writing by the provider and Maryland Physicians Care. As indicated in the Provider Manual and Quick Reference Guide, claim appeals must be submitted within 90 business days of the claim remittance advice, or it will be denied for timely appeals submission.
Providers can electronically submit the claims appeal at https://providerappeals.marylandphysicianscare.com/ or complete the Appeal Form here. Claim Appeal forms can be faxed to 1-833-656-0648 or mailed with medical records to:
Maryland Physicians Care
PO Box 1104
Portland, ME 04104
Practitioner’s Credentialing Rights
Practitioners can review information obtained during the credentialing/re-credentialing process upon request. This includes any outside primary sources utilized for credentials verification.
Also, if requested, the practitioner can receive status updates on his/her credentialing or re-credentialing application by contacting MPC’s Provider Credentialing Department.
MPC will respond to requests verbally and/or in writing within seven business days of recommendation by MPC’s governing body. Information shared with practitioners may include information obtained from outside sources, except for references, recommendations, or other peer-reviewed protected information.
To obtain a full copy of Practitioner’s Credentialing Rights, please contact MPC’s Provider Credentialing Department at 1-800-953-8854 or visit https://www.marylandphysicianscare.com/wp-content/uploads/2021/08/Practitioners-Credentialing-Rights.pdf
GLP-1 Inhibitors
MPC has a robust formulary, including coverage of GLP-1 inhibitors. The formulary agents for this class include Trulicity (dulaglutide) and Rybelsus (semaglutide). Documentation of an intolerance or allergy to both of these medications is required to approve a non-formulary agent, including Ozempic.
Additionally, due to Title 19 of the Social Security Act, MPC does not cover medications for weight loss. MPC cannot cover Mounjaro or any GLP-1 inhibitors for weight loss. This includes Wegovy and Ozempic when used for weight loss.
Hydrating for
Health
“Recent NIH-funded research suggests that avoiding dehydration may not be the only reason to ensure you drink enough fluids. Dr. Natalia Dmitrieva, a heart researcher at NIH, has studied the long-term effects of not drinking enough water. In one study, her team found that middle-aged people who were not adequately hydrated were more likely to develop chronic diseases. The diseases included heart failure, diabetes, chronic lung disease, and dementia.
These people were also more likely to age faster and die younger. So, staying hydrated might help you stay healthier as you get older…”
To read more on hydration, please visit Hydrating for Health | NIH News in Health
Allergies and Asthma During Spring
With the arrival of Spring comes seasonal allergies for our members. Common seasonal allergy symptoms consist of congestion, sneezing, itchy eyes, nose and throat, a runny nose, and more. However, members with both allergies and asthma may have more serious symptoms and issues.
People are unaware that allergies and asthma are connected, and anyone can suffer from both. Changing climates contribute to pollen season by warmer temperatures and longer growing seasons. Research from the National Institute of Food and Agriculture shows that “pollen season starts 20 days earlier, is 10 days longer, and features 21% more pollen than in 1990.”
Encourage your patients to be aware of the air quality during this time, both indoors and outdoors. The air we breathe affects our day-to-day living. Ensure they understand and use the medication prescribed to them and communicate with you during this season, especially if they have trouble controlling their allergies and asthma. Also, help them create a plan to manage their day-to-day life during this time of year to feel healthy and stay active. An action plan and more information can be found in the Self-Management Asthma & Allergies section of the MPC website.
Health and Wellness Education
MPC has several tools and resources available to members for their wellness journey. As a provider, you are in the perfect position to offer members credible, evidence-based health information. If there is a specific health topic your patient needs or wants to learn more about, please complete our Health Education Request Form. MPC has staff available to support members, community groups, organizations, and schools upon request and to participate in local events. We also provide printed tip sheets on specific chronic conditions or diseases to our members.
MPC Provider Portal
What can I do on the portal? MPC Provider Portal
- Check the status of claims
- View your Remittance Advices
- View PCP Member Panels
- Check Member’s Eligibility
- Request Prior Authorization
- View the Gaps in Care Report
- Add/Edit Portal Users
- And much more
Where can I find the MPC Portal User Guide?
Once in the Provider Web Portal, select MPC Provider Portal User Guide to view the Job Aid. The MPC Provider Portal is your one-stop online tool for managing user accounts and accessing eligibility and claims data. You can also access the Gaps in Care Reports. If you haven’t created an account already, go to our secure portal to create your account and get started today!
Keep Us Informed
MPC needs to be notified if your practice is unable to accept new members. It is important that we have accurate information in our provider directory, as members use the directory to select practitioners. By providing updated information, you can assist MPC in providing the best care we can for our members. We also need to know if you plan to move, change phone numbers, or change your network status. Call 1-800-953-8854 to update or verify your contact information or status. You can also check your information on our secure provider portal. Please let us know at least 30 days before you expect a change to your information.
VISIT OUR WEBSITE
To Find Helpful Information on:
- Quality Improvement Programs
- Population Health Management Programs
- Care Management Programs
- Health & Wellness Programs
- Clinical Practice Guidelines
- Utilization Management, including decision-making criteria, affirmative statement, and staff availability
- Pharmacy and Prescription Drug Management
- Benefits and Coverage
- Member Rights and Responsibilities
- Protected Health Information Use and Disclosure
- Provider Manual
- Member Handbook
- Provider Directory
- Credentialing Rights
If you do not have internet service, you can reach us by phone (numbers listed in “Who to Call” – below) for more information.
WHO TO CALL
MARYLAND HEALTHY SMILES DENTAL PROGRAM
1-855-934-9812
PUBLIC MENTAL HEALTH SERVICES
1-800-888-1965
SUPERIOR VISION
1-800-428-8789
UTILIZATION MANAGEMENT
1-800-953-8854
CASE MANAGEMENT
1-800-953-8854
HEALTH EDUCATION REQUESTS
1-800-953-8854
Referrals and MPC
Please note that MPC does not require referrals for specialist care.
HELP PREVENT
FRAUD AND ABUSE
MPC needs your help to prevent fraud and abuse! We encourage you to report anything suspicious you may have seen. You may report fraud and abuse without fearing retaliation by calling MPC’s Compliance Hotline at 1-866-781-6403 or visiting MPC Fraud and Abuse.
Enroll in ePREP
Are you enrolled in the electronic Provider Revalidation and Enrollment Portal (ePREP)? ePREP is a requirement for Maryland Medicaid providers. It is a one-stop shop for provider enrollment, re-enrollment, revalidation, information updates, and demographic changes. Please ensure you are enrolled and that your information is consistently kept up to date. Providers who do not enroll or have out-of-date information may not be paid for services to Maryland Medicaid recipients. Review these tips (.pdf) for getting started and for additional resources. Enroll or update your information at eprep.maryland.health.gov.