Maryland HealthChoice
- MedStar Medicare Choice/MedStar Select Provider website
- For Providers
- Make Provider Changes
- Provider Support
- Provider Resources
- Preauthorization and Utilization Management
- Refer a Patient to a Specialist
- Pharmacy
- Claims
- Check Claims Status
- Requirements: False Claims and Statements
- Fraud and Abuse Retractions
- Emergency Room Auto-Pay List
- Claims and Billing Procedures
- Claims Submission
- Electronic Claims Submission
- Timeliness of UM Decisions
- Denial Codes and Reasons
- Claims Appeals Procedures
- Claims and Refunds
- National Drug Code
- Modifier 32
- Modifier TH
- Observation Authorization
- Visual Evoked Response (VER) / Visual Evoked Potential (VEP)
- Quality Assurance and Monitoring Programs
Provider Access and Availability Requirements
Learn your requirements regarding member appointments and timeframes, and coverage for after hours.
Provider Manual
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. Download the Provider Manual
Quick Reference Guide
For MedStar Family Choice contact numbers and information about pre-authorizations.
MedStar Family Choice Quick Authorization Guide
A list of services that require pre-authorization.
PCP Assignment Changes
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.
Cultural Diversity Training
You can satisfy your cultural diversity training requirements by taking the education courses here.
CLAS Standards Toolkit
View the guide to implementing the National CLAS Standards.
Prior Authorization and Utilization Management
Information on prior authorization and utilization management along with forms.
Referrals
Primary care providers should use the Maryland Uniform Consultation Referral Form when referring to a specialist provider.
Provider Alerts
Provider alerts are frequently sent out to inform providers about changes in coverage, new policies, programs and more.
Provider Directory
Use our Find a Doctor tool to locate a provider near your patient.
Provider Newsletters
Provider newsletters are sent out quarterly.
Provider Education Orientation Slides
New providers can find a variety of details about MedStar Family Choice in this training as well as department contact information.
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.
Clinical Practice Guidelines
A listing of clinical practice guidelines for a variety of conditions.
Quality Improvement Programs
This training provides details of the quality improvement programs for the Maryland HealthChoice Program.
HPV Public Health Issue/Tools
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 Program
Living Well is a seven-week MedStar Health program that helps patients with chronic conditions take charge of their health and their life.
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.
Lead Testing
As a provider, it is important to follow the Lead Testing Schedule as it applies to Medicaid recipients.