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.
Provider News
Provider alerts and newsletters include important information for all MedStar Family Choice providers.
Provider Support
Learn about MedStar Family Choice departments and programs that works with and assists providers.
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.
Electronic Funds Transfer (EFT) / Electronic Remittance Advice (ERA)
Learn how to receive electronic claims payments faster and request ERAs.
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.
Diabetes Prevention Program
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.
Provider Orientation Training (On Demand)
New providers can find a variety of details about MedStar Family Choice in this training as well as department contact information.
Cultural Diversity Training
To satisfy your cultural diversity training requirements, please take the Embracing a SPIRIT of Diversity training via MedStar Health SiTEL. Click the heading above for the How to Enroll in an OnDemand Course on SiTEL instructions. If you do not have internet access, you can contact MedStar Family Choice Provider Relations at 800-905-1722, option 5 to request cultural diversity training.
Quick Reference Guide
For MedStar Family Choice contact numbers and information about pre-authorizations.
Interpreter Services
Interpreter for those members who have limited English proficiency, or hearing impaired, or sight impaired.
MedStar Family Choice Quick Authorization Guide
A list of services that require pre-authorization.
Quality Monitoring Programs
The Quality Improvement Department works closely with the Maryland Department of Health to ensure our members receive optimum care.
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.
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 Directory
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.
Clinical Practice Guidelines
A listing of clinical practice guidelines for a variety of conditions.
General Medical Records Release and Authorization Form
A form for patients to allow the release of their medical records and authorization for use or disclosure of protected health information.
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.