Transcript Claims Inquiry

Maryland Physicians Care
&
American Association of Healthcare
Administrative Management
June 21, 2013
Who We Are
Maryland Physicians Care (“MPC”) is a
Maryland Medicaid MCO owned by:
• Western Maryland Health System
• Meritus Health
• Maryland General Health System
• St. Agnes HealthCare
My MPC Source
HIPAA Compliant Website
Prior Authorization Search Tool
www.MarylandPhysiciansCare.com
The following information can be found on our website:
•Various Forms
•Provider Manual
•Current Drug Formulary
•Search the directory of participating providers
•Access to our Secure HIPAA Compliant Website
Member Eligibility
Member eligibility can be checked several ways:
1. Call EVS @ 866-710-1447
2. Log onto EVS at:
https://encrypt.emdhealthchoice.org/emedicaid/_Portal/
provWelcome.jsp
3. Log on to MPC’s Secure HIPAA compliant web
portal at:
https://MarylandPhysiciansCare.abovehealt
h.com
Claims Tips
• Fill out claim form completely including NPI #
• Timely filing limit for original submissions is 180
days from the date of service
• Send claim to proper address:
Maryland Physicians Care
Attn:Claims
PO Box 61778
Phoenix, AZ 85082-1778
Prior Auth Tips
Provide the following:
•Member information
•Clinical note/explanation of medical necessity
•Diagnosis and procedure codes
•Date(s) of Service
•When faxing use a cover sheet with correct phone &
fax numbers for your practice
•Fax to MPC at 800-953-8856
•For unscheduled admits fax to:
800-385-4169
Contact Information
Provider Relations
• 1-800-953-8854 option 2, option 4
Prior Authorization
• Monday – Friday 8:00am – 5:00pm
• 1-800-953-8854, option 2, option 2
• 1-800-953-8856 (fax)
• Secure HIPAA Compliant Website Link:
https://MarylandPhysiciansCare.abovehealth
.com/
Contact Information
Claims Inquiry
• 1-800-953-8854 option 2, option 3
• Secure HIPAA Compliant Website Link:
https://MarylandPhysiciansCare.abovehealth.com/
Appeals Inquiry
• 1-800-953-8854 option 2, option 7
• Fax: 1-866-831-0790
• Email: [email protected]
• Basic appeals status should be checked by calling
the claims inquiry number listed above
Contact Information
Claims Resubmission Address:
Maryland Physicians Care
Attn: Claims Resubmission
P.O. Box 61778
Phoenix, AZ 85082-1778
Appeals Address:
Maryland Physicians Care
Attn: Appeals
509 Progress Dr.
Linthicum, MD 21090
Contact Information
Special Needs Coordinator for Case Management
Services
• 1-800-953-8854 option 2, option 6
HEDIS Coordinator
• Roger Yates
• 410-401-9493 – Direct line
Questions?