ISSUE 1 / SPRING 2026
COMING SOON – NEW MPC PROVIDER PORTAL!
MPC’s Provider Portal is undergoing a refresh. Please be on the lookout for MPC’s updated Provider Portal powered through Availity.
You will still be able to obtain the information found on the portal today. You will continue to be able to access the items below and more!
- Patient eligibility
- Member panels
- Authorizations
- Claim status
- Contact Us
For providers needing assistance with Availity registration and training, please access the links below:
- Create Account – Set up an account to get started (self-service)
- More info/ Training – Helpful information/training options once account is created.
- Availity Support – Support from Availity once account is created
- Availity Training – Training videos/docs on how to use the Availity provider portal once account is created
We are excited for you to see our new look.
Maryland Medicaid to Sunset its Mandatory Provider Enrollment System (ePREP) – Effective October 1, 2026
Medicaid Transmittal 59-26 and PT 65-26 Provider Enrollment Portal Transmittals
Maryland Department of Health (MDH) announced on January 29, 2026, that Maryland Medicaid will be transitioning from ePREP, the current online provider enrollment and revalidation portal system, to a new Medicaid Provider Enrollment portal system set to go live in October 2026.
To prepare for the transition, Maryland Medicaid will be implementing a phased hold on ePREP applications. Once these holds take effect, providers must wait until the new system is available to make any enrollment updates, including new enrollments, revalidations, and any changes to existing enrollment accounts.
Effective July 1, 2026, applications may not be submitted in ePREP for high and moderate risk provider types.
Effective August 1, 2026, applications may not be submitted in ePREP for limited risk provider types.
Providers who are scheduled for revalidation between July 1, 2026, and the October 2026 MPRIME go-live date will have their revalidation rescheduled to be earlier this year.
For any questions regarding these transmittals or the MPRIME transition, please contact mdh.mprimegolive@maryland.gov.
Maryland Medicaid has created a FAQ document covering many of the key questions received by providers. This document can be found on Maryland Medicaid’s Provider Enrollment website at MDH Webpage Pages - mprime. The FAQ will be updated periodically as new questions arise.
What is the Maryland Prenatal Risk Assessment (MPRA) and Why is it Important?
The Maryland Prenatal Risk Assessment (MPRA) is an important Maryland Department of Health (MDH)-required form that asks pregnant patients questions about their demographics, medical health, and psychosocial risk factors. The answers provide direction on needed services to offer members.
MPRAs must be completed at the first prenatal visit and the completed form sent to the local county health department within 10 days. The MPRA responses are reviewed by the local health department and may lead to member outreach to assist with obtaining needed services before and after the baby’s birth.
MPC reimburses for the completion of one MPRA and development of the plan of care per pregnancy under CPT Code H1000. This reimbursement is in addition to the Evaluation and Management prenatal visit payment. The fillable MPRA can be found on the MPC website at Provider Resources - Maryland Physicians Care. Additional information is available on the MDH website at:
https://health.maryland.gov/mmcp/medicaid-mch-initiatives/Pages/MPRA.aspx
Maryland Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program Review Begins in March 2026
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 with the review process.
- Respond timely to record requests.
- Ensure that all faxed or mailed-in medical records are COMPLETE and include lab and immunization records.
- Schedule 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.
Kidney Health Awareness for Patients
Kidney disease is a serious condition that often develops quickly. In the United States, chronic kidney disease (CKD) affects more than 1 in 7 adults or about 14% of the population. It often goes undetected until later stages when symptoms become more noticeable.
Diabetes and high blood pressure are common causes; however, other health issues also damage kidneys. It is important patients are aware of the disease, understand the risks, and take steps to protect their kidneys.
Since early symptoms are often silent, regular screening and patient education is essential. When patients understand their risk and how CKD develops, they are aware and able to take active steps to protect their health.
How to help patients understand kidney disease:
- Use simple language to explain how kidneys function.
- Make results easier to understand by showing lab trends visually.
- Clarify that kidney disease is manageable with early care.
- Address any misconceptions or fears patients may have.
- Encourage patients to ask questions and create conversation.
Engaging patients in their healthcare and providing them with the education they need helps empower them. Supportive provider collaboration and engaged patients may help prevent chronic kidney disease.
Member Pulse Survey Results
MPC Member Ratings of Their Personal Provider
Below are the 2025 year-to-date 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. The results show that members are pleased with the services that you provided. We appreciate your commitment to your patients, and we congratulate you on your high satisfaction level!
Correct Coding Corner:
- Please review the MPC ED Claim Payment Process Rules for Provider-Submitted ED Claims found on the MPC website at: Billing and Claims - Maryland Physicians Care.
- Important Reminder: NPI-2 Updates
To avoid delays or disruptions to claims processing or authorizations, please notify us before making any updates to your NPI-2 organization number. Please do not submit claims using a new NPI-2 until you have notified us and the update has been completed in our system. This helps ensure continuity of payment and authorization processing. - Effective January 1, 2026, Maryland Physicians Care began implementing additional enhancements to our claims editing programs that promote correct coding and billing practices. This aligns with the MDH Transmittal—PT 50-26—which reminds providers of the National Correct Coding Initiative. Use of these claims edits will enable you and your billing staff to more readily understand our payment/denial of claims given the widespread use of these policies.
Practitioners’ Credentialing Rights
Practitioners may request to receive the information used during their credentialing or re-credentialing process. This includes any outside primary sources used to verify their credentials. They can also request application status updates by contacting MPC’s Provider Credentialing Department.
MPC will respond verbally or in writing within seven business days of the governing body’s recommendation. Information from outside sources may be shared, excluding references, recommendations, and other peer-reviewed protected content.
For a full copy of the Practitioner’s Credentialing Rights, please contact MPC’s Provider Credentialing Department at 1-800-953-8854 or visit Practitioners-Credentialing-Rights.pdf
Promoting Active Play for Children
Active play is important for healthy childhood development, supporting physical activity, social skills, and emotional well-being. Outdoor play allows for fresh air and activities such as exploring, running, and group play. Providers are a trusted source for parents when it comes to their children, and play may be a helpful discussion during well-child visits.
Ways to start the conversation:
- What kind of activities does your child enjoy the most?
- Do you feel comfortable with the play areas in your neighborhood?
- Where does your child usually play?
- Are there any safety or time concerns making active play difficult?
Safety concerns can become barriers to active outdoor play. Not all families have access to safe spaces for physical activity, and factors such as weather conditions, work schedules, and financial constraints can also limit opportunities.
Providers can:
- Recommend age-appropriate activities
- Remind parents of the safety needs for public spaces, like parks and playgrounds
- Suggest no-cost or low-cost activity options
- Connect families to local resources, such as community programs or recreation centers, when possible
Encouraging families to make outdoor play a part of their daily routine supports healthy growth and development of their children. When providers offer guidance and connect families to local resources, they help parents feel confident in creating safe active play opportunities that will support their child long term.
MPC Pharmacy: UM Update
The MPC pharmacy team has implemented a new update in Q4 2025 to support the prior authorization process for pharmacy benefit medications.
The UM process update addresses incomplete electronic prior authorization (ePA) submissions between the MPC pharmacy team and the requesting provider. The MPC pharmacy team will now be able to send incomplete ePA requests back to the requesting provider with instructions detailing what is missing from the submission. These instructions will appear directly on the provider’s dashboard of their ePA vendor’s system. The incomplete ePA submissions can include missing supporting documentation for the request, the use of an incorrect prior authorization form, or a prior authorization form that is partially complete. This will allow our providers to resubmit a new prior authorization with an updated PA form and/or include any supporting documentation that was missing from their original ePA submission to MPC. The goal is to further streamline the ePA submission process, improve medication access for our members, and minimize administrative barriers for our providers.
As a reminder, please continue to submit completed criteria and recent supporting clinical documentation for ALL prior authorization requests. Failure to supply required documents will delay the prior authorization review process and could result in a denial. Prior authorization requests can be submitted via the electronic prior authorization (ePA) process or via fax (1-833-896-0656) using our template forms found on our website here.
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://marylandhealthconnection.gov/checkin
- CALLING Maryland’s Health Connection’s Customer Service at 1-855-642-8572
- 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.
Health and Wellness Education
Short on time to educate your patients on the benefits of following your recommendations? Not to worry – MPC is here to help!
As a provider, you are in the perfect position to offer patients credible, evidence-based health information. We can provide the time needed to educate them with that information through our Prevention & Wellness (P&W) staff and several online tools and resources. You can quickly:
- Fill out a Health Education Request Form by visiting the website or scanning the QR Code below,
- Let them know that they can fill out a Member Health Education Form,
- Direct them to our Health and Wellness Library, or
- Contact the P&W staff directly at preventionandwellness@mpcmedicaid.com.
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.
Check out the rack card for more information:
Health Equity through Cultural Competency Training
Cultural competency in healthcare is the ability to deliver care that respects and responds to patients’ diverse values, beliefs, behaviors, and social, cultural, and linguistic needs.
Cultural competency training has been shown to increase provider effectiveness and patient satisfaction while helping reduce health disparities. It also supports higher-quality care and improved health outcomes.
In practice, cultural competency supports clearer communication, stronger trust, and more effective care for the increasingly diverse populations providers serve.
To support providers in this work, cultural competency training resources are available here: https://www.marylandphysicianscare.com/providers/cultural-competency-training/. These resources vary in format and focus and may include self-paced modules, virtual trainings, or continuing education opportunities.
Each resource includes details such as:
- Topics covered
- Length of training
- Cost (if applicable)
- Certifications or CMEs/CEUs offered
Providers are encouraged to review the available options and select training that aligns with their practice needs and patient populations.
Language Service Support
MPC provides quality-certified oral interpreter services for members. This service is also available for providers who need interpretation service during healthcare encounters with our members through our language line vendor.
If you have an MPC member in your office who needs assistance with oral translation, please call us at 1-800-953-8854 and request interpreter services.
HELP PREVENT
FRAUD AND ABUSE
You can report fraud and abuse in the following ways:
- CALL MPC’s Compliance Hotline at 1-866-781-6403.
- GO ONLINE at https://www.marylandphysicianscare.com/fraud-abuse/.
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. It is also important for us 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.
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.
Visit Our Website
Find 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
WHO TO CALL
PROVIDER SERVICES
Claims status, network participation, member eligibility, access language services during patient encounters, etc.
800-953-8854
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
CARE MANAGEMENT
800-953-8854
HEALTH EDUCATION REQUESTS
800-953-8854
RETAIL PHARMACY MEDICATION UM
888-258-8250
Referrals and MPC
Please note that MPC does not require referrals for specialist care.