Provider Pulse Surveys

We want to hear from you!

The results are based on respondents’ rating of MPC’s performance in various areas and are used to improve the provider’s experience with MPC.

Here are a few examples of the survey questions:

• Satisfaction with accuracy and timeliness of claims processing
• Satisfaction with process for verification of member eligibility
• Satisfaction with knowledge and efficiency of Provider Representatives
• Yes or no, would you recommend MPC to your patients.

Please assist us by responding to MPC Pulse Survey requests.

MPC Pharmacy: Utilization Management

MPC requires completed criteria and clinical documentation to be provided for ALL prior authorizations to support the requested treatment. Failure to supply required documents will delay the prior authorization review process. Please continue to complete prior authorization requests via the electronic prior authorization (ePA) process or via fax (1-833-896-0656) using our template forms found on our website here.

This pharmacy team is not responsible for the review of medical benefit medications (administered by a healthcare provider). Please continue to fax prior authorization requests for these medications to the MPC UM team at 1-800-953-8856.

CRISP

Using the Chesapeake Regional Information System for Patients (CRISP) improves continuity of care by providing you with information from other care team participants. It can also improve member satisfaction ratings. The annual Member Satisfaction Survey includes a question related to how informed their provider seemed to be about healthcare received from other providers.

CRISP is the State Designated Health Information Exchange (HIE) and Health Data Utility (HDU) for Maryland. They are a non-profit organization that facilitates the electronic transfer of clinical information between disparate health information systems.

CRISP offers monthly webinars to introduce new and existing users to CRISP.

You can access CRISP at https://crisphealth.org and MPC strongly recommends that you use CRISP in your day-to-day practice.

Pharmacy Benefit Coverage

Maryland Physicians Care is committed to delivering a cost-effective and inclusive medication formulary for our membership. We utilize a Preferred Drug List (PDL) that provides an overview of the medications we cover and details the utilization management requirements we have implemented for our formulary.

The procedures for prior authorization, step therapy, quantity limits, and exclusions are highlighted in the PDL. Reference links for medications that are carved out through Maryland Medical Assistance have been updated. In addition, a section on Copayment requirements has been added. The most up-to-date version of our PDL is listed here: For Providers -> Approved Drug Benefits. The section also includes monthly formulary change updates and formulary recommendations for asthma controller medications and HIV medication management. For any questions regarding pharmacy prior authorizations or requests for a printed copy of our PDL, please call 1-800-953-8854.

Family Planning Benefits

Family Planning Benefits provide individuals and couples with access to information and support when making decisions about reproductive health, family planning, and when to start a family. Providers should offer timely family planning appointments with patients. These appointments should be scheduled within 10 days of the member’s request.

Maryland Physicians Care offers a variety of family planning services for members, such as:

• Office visits for family planning services.
• Laboratory tests, including pap smears.
• Oral contraceptives that must have a 12-month supply to be dispensed for refills.
• FDA-approved contraceptive devices, methods, and supplies.
• Immediate postpartum insertion of IUDs.
• Emergency contraceptives and condoms without a prescription.
• Voluntary sterilization: however, this is not a self-referral procedure.
  • MPC members must be 21 years of age and use an in-network provider or have prior authorization to use out-of-network care.

Many pregnant members are eligible for Medicaid during pregnancy and postpartum. During this time, they receive full benefits and are automatically enrolled in the Family Planning Waiver Program to support their continued care.

• At the first prenatal visit for ALL Medicaid members, the Maryland Department of Health (MDH) requires the completion of the Maryland Prenatal Risk Assessment (MPRA).
  • The assessment helps to support our pregnant members.
  • The form MUST be completed and faxed to the Local Health Department (LDH) in the member’s residence county within 10 days.

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.

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!

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.

Referrals and MPC

Please note that MPC does not require referrals for specialist care.