ISSUE 2 / SUMMER 2026
Summer 2026, Maryland Medicaid to Sunset ePREP, its Mandatory Provider Enrollment System.
Via Medicaid Transmittals 59-26 and PT 65-26, Provider Enrollment Portal Transition, Maryland Department of Health (MDH) announced that Maryland Medicaid will transition from ePREP, the current online provider enrollment and revalidation portal system, to Maryland Provider Registration and Information Management Enterprise (MPRIME), a new Medicaid provider enrollment portal.
MPRIME is scheduled to go live in October 2026.
Providers who are scheduled for revalidation between July 1 and October 2026 MPRIME go-live date will have their revalidations rescheduled to be completed earlier. Providers who do not complete their revalidations in time may be suspended.
For any questions regarding these transmittals or the MPRIME transition, please contact mdh.mprimegolive@maryland.gov. Maryland Medicaid has created an FAQ document covering many of the key questions received by providers. This document can be found on Maryland Medicaid’s Provider Enrollment website at the MDH webpage Pages – mprime. The FAQ will be updated periodically as new questions arise.
Supporting Healthy Pregnancies Through the Maryland Prenatal Risk Assessment (MPRA)
An MPRA is required for all pregnant Maryland Medicaid participants and must be completed at the first prenatal visit. The MPC fillable MPRA form found here ensures accuracy and legibility.
Completed forms must be submitted to the local county health department within 10 calendar days of the visit. Based on identified risks, members may be connected to services such as care coordination, home visiting programs, substance use disorder treatment (including the MOM Program), nutrition assistance (such as WIC and SNAP), and community-based resources addressing housing, transportation, food insecurity, and other social needs. Timely use and submission of the fillable MPRA form supports early intervention and improved maternal and infant outcomes.
MPC reimburses for the completion of one MPRA and development of the plan of care per pregnancy under CPT H1000. This reimbursement is in addition to the Evaluation and Management prenatal visit payment.
Maintaining Appointment Availability: A Shared Commitment to Member Care
Quarterly Appointment Accessibility Surveys
MPC conducts quarterly Appointment Accessibility Surveys to assess whether members can schedule appointments within required timeframes. Survey results are used to monitor compliance and identify potential access gaps.
Know the Standards
Appointment accessibility standards are established by applicable regulatory and accrediting agencies and are detailed in the MPC Provider Manual. For convenience, these standards are also available as a handout and staff training tool through your designated Provider Relations Representative.
How Practices Can Support Compliance
To help maintain compliance with access standards, practices are encouraged to:
- Regularly review scheduling to ensure adequate appointment slots
- Monitor wait times for routine and urgent visits
- Train staff on appointment accessibility requirements: Appointment Scheduling Standards
- Promptly address barriers that may limit timely access for members
Maintaining appropriate appointment availability supports continuity of care and helps reduce unnecessary emergency department utilization.
What is HEDIS?
HEDIS® (Healthcare Effectiveness Data and Information Set) is a valuable tool for healthcare providers, helping them understand their performance and improve care for their patients. By understanding the HEDIS measures and incorporating them into daily practice, providers can identify and address care gaps and ensure they are meeting the standards set by the National Committee for Quality Assurance (NCQA).
Understanding Performance and Identifying Gaps:
- HEDIS measures provide a standardized way to assess the quality of care delivered by health plans and, by extension, the providers within those plans.
- By tracking HEDIS measures, providers can identify areas where they are excelling and areas where they need to improve.
- Tracking HEDIS measures allows for more targeted quality improvement efforts, focusing on areas where patients' outcomes can be most positively impacted.
Improving Patient Outcomes and Engagement:
- HEDIS measures often focus on specific areas of care, such as chronic condition management, preventive care, and access to care.
- By actively addressing these focus areas, providers can improve patient outcomes, promote better health literacy, and encourage patient engagement in their care plans.
MPC is accountable for the timeliness and quality of healthcare services delivered to its diverse membership. MPC reviews HEDIS rates on an ongoing basis and continually looks for ways to improve. It is an important part of our commitment to providing access to high-quality and appropriate care for our members. MPC makes HEDIS gaps-in-care reports available on the provider portal and provides HEDIS Tip Sheets on the provider website to assist practices with identifying HEDIS measures to engage members in care.
Preventive and Clinical
Practice Guidelines
Maryland Physicians Care (MPC) encourages you to become familiar with its Preventive and Clinical Practice Guidelines. For the most up-to-date version of our preventive and clinical practice guidelines, please visit:
MPC adopts preventive and clinical practice guidelines based on the health needs of our membership and opportunities for improvement identified as part of the quality improvement (QI) program. Guidelines are available for preventive services, as well as for the management of chronic conditions, to assist in developing treatment plans for members and to help them make healthcare decisions. MPC evaluates providers’ adherence to the guidelines at least annually, primarily by monitoring relevant HEDIS measures.
Correct Coding Corner:
Maryland Physicians Care promotes 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.
It is important that your demographic data with MPC is complete and correct. Your demographic information may be listed in the MPC provider directory and drives accurate payment and timely credentialing. If you have not already done so, please update our records to include languages spoken, race, and ethnicity. This provides information that is frequently requested by members.
Understanding Health Literacy
Accessibility of care is not only about access to care, it’s also about understanding care.
Health literacy refers to a patient’s ability to find, understand, and use health information to make informed decisions.
When patients do not fully understand their diagnosis, medications, or next steps, it can lead to:
- Missed appointments
- Medication errors
- Poor chronic condition management
In practice, providers can support appropriateness and accessibility of care by:
Using plain language
Avoid medical jargon and explain information in simple, clear terms
Confirming understanding
Ask patients to repeat instructions in their own words (“teach-back” method)
Breaking information into steps
Focus on 1–3 key points per visit to avoid overwhelming patients
Using visual aids when possible
Diagrams or written instructions can reinforce understanding
Encouraging questions
Create an environment where patients feel comfortable asking for clarification
Health literacy challenges can affect any patient, but they disproportionately impact individuals with limited English proficiency, lower income, or less access to education.
By prioritizing clear communication, providers can reduce barriers, improve patient engagement, and support more equitable health outcomes. Free training for providers on “Health Literacy and Public Health” can be found on the MPC website’s Cultural Competency Training Page.
Sun Safety and UV Protection
As summer brings warmer weather, it brings an opportunity to remind patients of sun safety. While it is not possible to avoid sunlight altogether, we can share ways to protect them and reduce UV exposure.
Ultraviolet (UV) rays are invisible rays from the sun. While they are unseen, they can affect the skin and eyes even when the sun does not feel strong. Over time, being exposed to UV rays can lead to skin damage and other health risks.
Of the three types of ultraviolet rays, UVA and UVB are the ones that reach the skin and are most important for sun safety. What is the difference between the two?
- UVA rays are present year-round, including cloudy days and they go deep into the skin. This type of ray contributes to aging skin, wrinkles, and long-term skin damage. UVA rays are a risk factor with skin cancer.
- UVB rays are strongest in the late morning and afternoon hours. This type of ray affects the skin’s outer later. UVB rays damage skin cells and increase the likelihood of skin cancer.
The best way to reduce UV exposure is to limit direct sunlight during midday, when UV rays are their strongest. Some individuals are at a higher risk, including those with fair skin, a history of sunburn or skin cancer, those who have a condition that affects their immune system, and individuals taking medication that is sensitive to sunlight. While skin pigmentation provides some protection against UV rays, people of color are still at risk for skin damage and skin cancer, making sun protection important for everyone.
As patients spend time outdoors, they should wear sunscreen and reapply as needed. Additional ways to stay protected include seeking shade when it is available, and wearing clothing that protects the skin, including a wide brimmed hat and sunglasses.
Providers should encourage patients to have their skin checked regularly and report any new or changing spots. Sun protection is needed for all skin tones and inclusive education helps reduce UV rays, lower the risk of skin cancer, and supports overall skin health.
MPC Pharmacy: UM -- Drug Information Resources
The MPC pharmacy team strives to improve transparency around the administration of utilization management strategies and formulary updates for the pharmacy benefit administration. The team encourages the use of electronic prior authorizations (ePA) to submit pharmacy benefit requests. If there is an error with using your ePA vendor, please contact the help desk of your vendor for prior authorization submission support. The MPC pharmacy team cannot provide technical support for ePA submission errors.
All current MPC prior authorization forms have been posted on our website to support fax/telephonic prior authorization requests. In the event that there is an issue submitting a prior authorization electronically, please refer to the prior authorization forms here.
Prior authorization forms, with supporting documentation, may be faxed to the MPC Pharmacy UM team at 1-833-896-0656. In addition, the policies for medical benefit medications are posted under the drug benefit section of our website and are listed 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.
How Care Management Helps Your Practice
Care Managers support MCP members with conditions such as asthma, diabetes, sickle cell disease, HIV/AIDs, and heart failure. Our Care Managers are trained nurses and practitioners who are here to support you and your staff, as well as assist your patients and their caregivers. They serve as advocates and care coordinators and help organize services as well as a support for adherence to plans. Their goal is to help ensure your patients receive high quality and cost-effective outcomes.
How Care Managers Support Your Practice:
- Represent the members’ needs and preferences.
- Coordinate care and services the patient needs.
- Connect members, providers, care teams, and families to help reduce gaps in care.
Benefits of Care Management:
- Care Managers educate members on the importance of following their treatment plans and help reinforce provider recommendations.
- They explain the potential health risk and complications that occur when members do not follow the providers’ treatment plan.
If you would like to refer a member to care management, please email the Special Needs Coordinator at MPCSNC@mpcmedicaid.com.
For more information regarding MPC Care Management services, call 1-800-953-8854.
Cancer Survivor Awareness
As of January 2025, according to the American Cancer Society about 18.6 million people in the United States have a history of cancer. The number of survivors varies by state, as it reflects a variation in population size.
June is Cancer Survivor Awareness Month; let us take the time to recognize those individuals who are living beyond their cancer diagnosis. Almost half of all cancer survivors were diagnosed within the past ten years. With early detection and effective treatments, survival has increased, yet many need additional care related to their cancer or treatment.
As a provider, you can help patients manage life after cancer treatment and prepare for possible long-term or late effects. For some, completing treatment often brings relief yet many survivors may experience physical or emotional changes, or changes in the support they receive. Regular follow-up visits and open communication about physical and emotional concerns help patients feel supported and receive appropriate care.
Encourage patients to discuss:
- Any physical concern affecting their daily life
- Any new medications, vitamins, or supplements
- Any changes in family history
- Any emotional concerns, such as depression or anxiety.
A cancer survivor’s care changes the focus. It is no longer about the cancer treatment and remission, but ongoing support for their health and quality of life. This is an opportunity to support lifestyle and preventive health changes within the survivor's day to day. Encourage patients to take part in eating healthy, exercising, and getting routine health screenings. Providers should continue to encourage smoking cessation and drinking alcohol in moderation.
As the population of cancer survivors grows, care must expand beyond treatment. Long-term care centered around support for the patient is critical in the survivor’s recovery, how they manage ongoing concerns, and their quality of life.
ADA Physical Accommodations Training for Providers
Does your provider practice location have ADA-accessible equipment? Do you and your staff know how to use this equipment?
Support accessibility in your practice.
MPC offers a free ADA.gov training guide to help providers correctly use physical disability accommodation equipment in office settings or on members’ personal devices.
This training covers:
- ADA physical accommodation requirements
- Answers to common compliance questions
- Step-by-step instructions with visual aids
Language Service Training
Maryland Physicians Care (MPC) serves a culturally and linguistically diverse population, with members speaking more than 25 primary languages other than English.
MPC provides training to help providers deliver effective communication and language assistance services. A guide which builds cross cultural communication skills is available to help you better understand members’ needs, values, and preferences, supporting more collaborative patient care.
This training guide, Effective Communication and Language Assistance - The Guide to Providing Effective Communication and Language Assistance Services, is offered by the Office of Minority Health/DHHS and the link to the training can be found on our Provider website.
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/.
What can I do on the MPC Provider Portal?
- Check the Status of Claims
- View your Remittance Advices
- View PCP Member panels, including member’s spoken language
- Check Member’s Eligibility
- Request Prior Authorization
- View the Gaps in Care Report
- Add/Edit Portal Users
- And much more
Referrals and MPC
Please note that MPC does not require referrals for specialist care.
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
Published on: June 4, 2026