What's New:
- Provider Registration in MedStar Provider Portal (to view claims). Learn how to register as a Provider using our new MedStar Provider Portal.
- How to Register for and Other Helpful Tips for Change HealthCare’s EFT and ERA Enrollment
- ECHO Provider Payments Portal User Guide
- Provider Payments FAQ
- Targeted Town Hall Information / Targeted Education Slide Deck Reviewing Changes for 2023
Check out streamlined resources for our provider network related to COVID-19.
Provider Access and Availability Requirements
Learn your requirements regarding member appointments and timeframes, and coverage after hours.
The MedStar Family Choice Provider Manual provides information on the HealthChoice program, the requirements of an MCO, and the requirements of providers participating in MedStar Family Choice.
Provider alerts and newsletters include important information for all MedStar Family Choice providers.
Learn about Provider Relations, Case Management, Outreach and other departments that work with and assist providers.
The CDC National Diabetes Prevention Program (DPP) is now a covered benefit for members of MedStar Family Choice. The DPP is a yearlong lifestyle-change program with a wealth of scientific studies supporting its effectiveness at reducing the risk of developing type 2 diabetes in at-risk individuals.
Pediatric to Adult Healthcare Transition Guide
Learn how to help your adolescent patients successfully transition from a child centered health care to an adult centered health care.
MFC Maternal Child Health Community Services Referrals
This referral service listed above is currently only available to members in Prince Georges County.
Office Laboratory/Pathology Procedure Codes
MedStar Family Choice requires laboratory/pathology procedures to be provided by MedStar Family Choice participating lab(s). The document linked above lists the procedure codes for labs that can be performed in an office setting.
For MedStar Family Choice contact numbers and information about pre-authorizations.
Interpreters for those members who have limited English proficiency or are hearing impaired or sight impaired.
MedStar Family Choice Quick Authorization Guide
A list of services that require pre-authorization.
The Quality Improvement Department works closely with the Maryland Department of Health to ensure our members receive optimum care.
Mental Health and Substance Use Resources for Providers
Learn how to refer a patient to mental health or substance use disorder treatment.
To change a member's primary care provider in our records, providers can help them complete the Member PCP Selection Form on the PCP Assignment Changes page.
View the guide to implementing the National CLAS Standards.
Prior Authorization and Utilization Management
Information on prior authorization and utilization management along with forms.
Primary care providers should use the Maryland Uniform Consultation Referral Form when referring to a specialist provider.
Use our Find a Doctor tool to locate a provider near your patient.
Billing Guidelines for Developmental/Mental Health Screening and Assessment
These are Maryland Department of Health's coding guidelines for developmental/mental health screenings by primary care providers.
A listing of clinical practice guidelines for a variety of conditions.
General Medical Records Release and Authorization Form (Spanish)
A form for patients to allow the release of their medical records and authorization for use or disclosure of protected health information.
MedStar Family Choice needs your help in addressing the critical public health issue of under-vaccination of Maryland's adolescents and young adults against the Human Papillomavirus (HPV). The Maryland Department of Health has a variety of tools available for providers.
Living Well is a seven-week MedStar Health program that helps patients with chronic conditions take charge of their health and their lives.
Maryland Healthy Kids/EPSDT Program
EPSDT is the Early and Periodic Screening, Diagnosis and Treatment Program (also known as the Healthy Kids Program) through the State Medicaid Program. This program establishes preventive care standards for children under the age of 21.
As a provider, it is important to follow the Lead Testing Schedule as it applies to Medicaid recipients.
Out of Network Doula Services Process for Prior Authorization
Take a look at the process for Prior Authorization for out of network Doulas.
Maryland Prenatal Risk Assessment Form
Information current as of: