ISSUE 1 / SPRING 2025
Maryland Healthy Kids Program (EPSDT) Review Begins in March 2025
The Maryland Department of Health (MDH) conducts an Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program medical record review each year 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—conducts the review. MDH requires that all providers participate and fully cooperate by:
- Responding timely to record requests.
- Ensuring that all faxed or mailed-in medical records are COMPLETE and include lab and immunization records.
- Scheduling onsite reviews promptly upon request.
PLEASE NOTE that it is all practitioner’s contractual obligation to cooperate with MDH audits and provide evidence of compliance for these reviews.
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.
Adopting Healthy Snacking Habits
Providers play a large role in their patients’ health and wellness. For individuals with type 2 diabetes, additional support while adopting healthier dietary habits, including mindful snacking, is often necessary. Snacking is an important part of managing blood sugar, maintaining energy, and regulating glucose levels.
It is important for those with diabetes to be informed of diabetes-friendly snacks and what to look for. Patients with type 2 diabetes should aim for a balanced mix of protein, healthy fats, and carbohydrates. These macronutrients, if perfectly balanced, provide the necessary energy and support vital bodily functions. Providers should encourage patients to read nutrition labels carefully and avoid snacks with high levels of added sugars.
Providers should support and motivate patients to view snacking as an opportunity to nourish their bodies with essential nutrients. By recognizing snacking as a tool to manage their diabetes, patients can choose snacks that help them feel satisfied and maintain stable blood sugar levels. Overall, intentional changes can lead to significant improvements in glycemic control and overall health. The Healthy Eating section of the self-management tools is a great resource for guidance!
Health and Wellness Education
Knowledge is power! Our goal is to make access to Health Education for your patients–our members–easier to access. Patients with low health literacy are more likely to visit the ER, have more hospital stays, less likely to follow treatment plans, and have higher mortality rates.
MPC has several tools and resources available to members to improve their health literacy and overall wellness journey. As a provider, you are in the perfect position to offer patients 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 one-on-one and in community group settings upon request, and to participate in many local events. We also provide member-targeted tip sheets on specific chronic conditions or diseases to our members. Check out the Health and Wellness Library to view these resources.
Doulas and MPC
As stated in the Maryland Department of Health Medicaid Doula Services program manual, effective February 21, 2022, Maryland Medicaid provides coverage for doula/birth worker services to Medicaid beneficiaries. A doula, or birth worker, is a trained professional who provides continuous physical, emotional, and informational support to birthing parents before, during, and after birth.
Certified doulas serving Maryland Medicaid members will provide person-centered, culturally-competent care that supports the racial, ethnic, and cultural diversity of members while adhering to evidence-based best practices.
MPC contracts with doulas who provide in-person and virtual services. Labor and delivery services will always be in person. You are encouraged to refer members seeking doula services to MPC’s Special Needs Coordinator at mpcsnc@mpcmedicaid.com.
MPC Provider Portal
Need Assistance?
- Where can I find the status of my claims?
- How can I view my Remittance Advice?
- Can I check an MPC member’s eligibility?
- As a PCP, where can I view my Member Panel or Gaps in Care report?
These tasks and more can be completed through the MPC Provider Portal.
MPC PORTAL USER GUIDE
To locate the MPC Provider Portal user Guide, access the MPC Provider Portal and select MPC Web Portal Admin Job Aid on the top menu bar under your name. The MPC Provider Portal is your one-stop online tool for managing user accounts, accessing eligibility and claims data. To create an account, visit our secure portal and get started today!
MPC Correct Coding Corner
- Reminder: MPC Members cannot be balanced billed for covered services nor charged for missed appointments.
- Home blood pressure monitors are covered through MPC. If your patient would benefit from using blood pressure monitors at home, please direct the member to an MPC in-network DME vendor. No prior authorization is needed for the blood pressure monitor. Remote patient monitoring will require prior authorization.
- Effective April 15, 2025, when billing for chemotherapy administration Revenue Codes 331, 333, and 335, please add the chemotherapy drug on the claim using the appropriate drug revenue code.
- As stated in the MDH EPSDT Transmittals No. 50-25 and No. 67-25, PCPs can and should conduct and bill for developmental screenings and behavioral health screenings administered during a well-child visit, in accordance with the MD Healthy Kids Preventive Health Schedule. PCPs may use CPT Code 96110 to bill the screening. Effective January 1, 2025, reimbursement for this and other specified assessment codes have increased by 10 percent.
- Pregnant members between 32- and 36-week’s gestation are eligible to receive the RSV vaccine, CPT 90678, without prior authorization. Please include the appropriate diagnosis code, Z3A.32 – Z3A.36, to your claim with the RSV vaccine for ease of claims administration.
- As a reminder, you must schedule follow up appointments with MPC members within 15 calendar days of an Emergency Department Visit or inpatient admission discharge.
- Hospital providers, please use the MPC “Post Acute Request Form” for prior authorizations to post-acute facilities regardless of MPC being the primary or secondary payor. The prior authorization form is mandatory for use and authorization requests for post-acute facilities will be rejected if not presented on the authorization request form or missing required information such as post-acute facility NPI and fax number. This form can be found at the following link: https://www.marylandphysicianscare.com/providers/provider-forms/
Pulse Survey Results
MPC Member Ratings of Their Personal Provider
Below are the 2024 Member Survey results of satisfaction with their PCP and specialty care providers. This rating is based on a 5-point scale where 5 represents the highest level of satisfaction and our target goal is 4.5. Members are pleased with the services provided. We thank you for your commitment to your patients and we congratulate you on your high satisfaction level.
Member Pulse Survey | 2024 Telephonic Survey Results
| Survey Question Rates | Q1 | Q2 | Q3 | Q4 | Average |
| Satisfaction with primary care provider | 4.69 | 4.54 | 4.71 | 4.64 | 4.65 |
| Satisfaction with specialty care provider | 4.61 | 4.32 | 4.80 | 4.58 | 4.58 |
Practitioner’s Credentialing Rights
As a practitioner, you may request information obtained during the credentialing and re-credentialing process, including external primary sources used for verification. You can also receive a status update on your application by contacting MPC’s Provider Credentialing Department.
Requests, whether written or verbal, will be responded to within seven business days following recommendations by MPC’s governing body. Information shared with practitioners may come from external sources, excluding references, recommendations, and other peer-reviewed protected information.
To obtain a complete copy of Practitioner’s Credentialing Rights, contact MPC’s Provider Credentialing Department at 800-953-8854 or visit MPC Practitioners Credentialing Rights.
Supporting Members At Risk for Diabetes
Type 2 Diabetes is a concern worldwide, with many individuals at risk due to lifestyle, genetics, and other factors. Providers are able to identify at-risk individuals, educate them on prevention, and support them through lifestyle change.
Risk factors include:
- Family history of diabetes
- Over the age of 45
- Certain ethnic backgrounds, such as African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander
- Overweight or obesity
- Hypertension
Educating patients on selecting balanced meals, recommending weekly moderate exercise, and emphasizing the importance of building habits into their daily routines are ways you can help. Encourage regular screenings, especially for those with multiple risk factors.
By supporting and empowering patients with the tools they need, providers may help prevent or delay type 2 diabetes, allowing patients to achieve healthier lives and reduce their risk. You can also direct your patients to the MPC prediabetes web page and the self-management tools for nutrition and exercise guidance.
Diabetes Prevention Program for Members
MPC offers a Diabetes Prevention Program (DPP) for members between the ages of 18 and 64. This is a FREE program for those at risk of type 2 diabetes; but do not have diabetes.
Members who qualify for the program will work with a trained lifestyle coach. This is a 12-month program that takes place in person or online with an in-network DPP provider. There are 16 weekly sessions, 6 monthly sessions, and group support that is available.
The program provides members – your patients–the resources to learn how to eat healthier, reduce stress, and increase their physical activity. Members will also become aware of their A1C, Blood Pressure, and Cholesterol, as these affect diabetes. Alongside the DPP Provider, members will know their numbers and build a prevention plan.
As a provider, you can refer your patients to the Diabetes Prevention Program or have them call Member Services at 1-800-953-8854 to see if they qualify. A free CDC prediabetes online screening is also available for patients in the self-management tools section of our website.
HELP YOUR PATIENTS KEEP THEIR MEDICAID COVERAGE WITH MPC!
Maryland Medicaid requires members to renew their coverage.
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://www.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.
For more information to assist your patients, please visit the MDH website at https://health.maryland.gov/mmcp/Pages/home.aspx.
HELP PREVENT
FRAUD AND ABUSE
MPC needs providers’ help to prevent fraud and abuse! We encourage you to report anything suspicious. Fraud and abuse occur when someone gives false information to receive healthcare benefits and/or services. Examples of fraud and abuse include:
- Someone using an ID card that does not belong to them.
- Under-reporting income and insurance or resources and assets.
- Billing for services or supplies that were not provided.
- Providing unsolicited supplies to beneficiaries.
- Misrepresenting a diagnosis, a beneficiary’s identity, the service provided, or other facts to justify payment.
- Prescribing or providing excessive or unnecessary tests and services.
- Selling prescription medications or making changes to a written prescription.
It is important to note that reporting fraud and abuse can be done without the fear of reprisal. You do not need to give us your name or contact information to report fraud and abuse, but if you do, we will keep it confidential. It is important that you give us as much information as you can because it will help us do a complete and thorough investigation. Reporting fraud and abuse can be done through:
- CALLING MPC’s Compliance Hotline at 866-781-6403 and leave a detailed message.
- GOING ONLINE at Fraud & Abuse – Maryland Physicians Care to complete the Fraud and Abuse Form.
- WRITING to the Compliance Officer at MPC, 1201 Winterson Road, 4th Floor, Linthicum Heights, MD 21090
Fraud and abuse are against the law. MPC reports all suspected incidences of fraud and/or abuse to the Maryland Department of Health, Office of Inspector General for further investigation, which can result in criminal penalties.
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
855-934-9812
PUBLIC MENTAL HEALTH SERVICES
800-888-1965
SUPERIOR VISION
800-428-8789
UTILIZATION MANAGEMENT
800-953-8854
CASE MANAGEMENT
800-953-8854
HEALTH EDUCATION REQUESTS
800-953-8854
Referrals and MPC
Please note that MPC does not require referrals for specialist care.
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.
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 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.