The following HEDIS Tip Sheets have been created to reflect NCQA HEDIS 2020-2021 Technical Specifications and may be used as a reference to help you increase your practice’s HEDIS rates. CRC Screening Promotion Toolkit Feedback Form (PDF)Īs you may know, quality of care is measured through the Healthcare Effectiveness Data and Information Set (HEDIS).CRC Screening Messaging for Targeted Populations (PDF).Local CRC Screening and PN Resource List (PDF).CRC Screening Patient Reminder Letter Template (PDF).CRC Questionaire Provider Letter Template (PDF).Cancer Screening Patient Questionnaire (PDF).
Increasing CRC Screening Resource List (PDF). CRC Screening Minimal Clinical Elements Summary (PDF). CRC At-a-Glance for Providers and Administrators (PDF). CRC Screening Promotion Toolkit Intro and Content Summary (PDF). For resources and information about clinical practice guidelines, preventive guidelines, and substance abuse guidelines please click on the below links.Ģ020 Updates to the Asthma Management Guidelines (PDF)Ģ021 Clinical Preventive Services Guidelines (PDF)Ģ020 MDH Childhood Lead Exposure Guidelines Maryland Physicians Care encourages the use of Care Guidelines to ensure the delivery of quality care. Non-Par/Specialty Network Providers (PDF). Guidelines and Proceduresīelow you will find helpful guidelines and procedures of our health plan: Please note that member consent is required. We will not take any punitive action against a provider for utilizing our provider complaint process. Previously denied claims are paid within 30 days of the appeal decision when a claim denial is overturned. Maryland Physicians Care resolves denial of payment appeals (including a second-level appeal within 90 business days of receipt of the initial appeal by Maryland Physicians Care). Second-level appeals must include additional information or documentation for consideration. Providers are allowed 30 days from the date of Maryland Physicians Care’s appeal determination to file one subsequent level of appeal for consideration. Maryland Physicians Care acknowledges provider written appeals within five business days of its receipt. Providers have 90 business days to file an appeal from the date of claim denial. TIMEFRAMES RELATED TO THE APPEALS PROCESS Maryland Physicians Care requires all provider appeals to be submitted in writing to: Check the prior authorization grid or contact MPC for details or with any questions. Note: A prior authorization may still be required for services. Please note that a noncontracted provider will not be reimbursed without prior authorization. If an in-network specialist is not available, we may issue a prior authorization for a referral to a noncontracted provider. Please complete the form and mail or fax it to our Case Management department immediately upon confirmation of pregnancy. Additionally, as a PCP or PSP, you should provide pertinent referral information to the participating MPC health professional to whom you refer the member.Ī prenatal risk assessment form is required for obstetrics services. If you are a PCP, you also ensure that members you refer to specialists return to your care as soon as appropriate.ĭocumentation of the referral in the enrollee’s medical charts is required. HealthChoice Self-Referral and Emergency Services Manual (PDF)Īs an MPC Primary Care Physician (PCP) or Primary Specialist Provider (PSP), you are responsible for initiating and coordinating referrals of enrollees for medically necessary services beyond the scope of your practice. Cpt manual professional edition 2018 how to#
For information on how to contact MPC or submit a claim refer to our Quick Reference Guide.Whether you are looking for information about covered services, specific treatment protocols, or how claims are handled, your MPC provider manual is a comprehensive resource. Provider Manual Helpful Information at Your Fingertips Maryland Healthy Kids EPSDT Schedule (PDF).Revised FFS Medicaid EPSDT Manual (PDF).Maryland Department of Health (MDH) Notices
Diabetic Medication Shared Decision-Making Aid (PDF)įind Coronavirus Resources (PDF) to help members during this time.Chesapeake Regional Information System for our Patients -CRISP.
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