COVID-19 Information

MedStar Health Locations Are Safe and Ready to Serve You

Many of us are experiencing fear and anxiety about the COVID-19 pandemic, especially when seeking medical care. MedStar Family Choice wants to make sure you don’t delay your medical needs or ignore symptoms. Early detection and treatment are important to effective care. MedStar Health has put a great deal of effort, time, and attention into protecting you while providing the care you need in the most appropriate and safe setting. Click here to learn more about how MedStar Health is protecting patients during this pandemic.

MedStar eVisit is available 24/7

Did you know you can speak to a medical professional about Coronavirus (or any other illness) at no cost from your smartphone or computer? Click here to learn more about our MedStar eVisit service.

COVID-19 Symptom Checker

In an effort to protect you and your family, we encourage MedStar Family Choice members to use our COVID-19 symptom checker by clicking here or texting COV19 to 77877. Our interactive health chat allows you to assess your risk based on your symptoms and potential exposure, then directs you to appropriate options for further evaluation where needed. You can also view information related to prevention, travel, self-quarantine, and sign-up to receive ongoing updates and alerts about the coronavirus. If you are experiencing a medical emergency (such as severe shortness of breath, chest pain or altered mental status), please call 911 and request an ambulance.

Medication Warnings

Please see the warning about chloroquine and hydroxychloroquine. These medications may or may not help Coronavirus patients get better faster. But it is easy to overdose on them.

Do you need to reach the HealthChoice Helpline?

Due to the state of emergency, the Maryland Department of Health's HealthChoice Helpline has transitioned to a voicemail system, effective immediately. When members call the line (1-800-284-4510), they will be instructed to leave a voicemail with their name and contact information. HealthChoice Helpline staff will then call the participant to assist with their issue. "No caller ID" may show when staff return the call. 

The voicemail option will be available Monday through Friday from 8 AM to 5 PM. 

Do you want to stay up-to-date on COVID-19 in Maryland?

The Maryland Department of Health created a Medicaid COVID-19 Participants Updates Webpage. This page provides the latest Medicaid information during the COVID-19 outbreak. For more general information about the Coronavirus (COVID-19) in Maryland, please visit The Hogan Administration’s COVID-19 Response website and Maryland Department of Health's COVID-19 website.

COVID-19 Updates

90-Day Supply of Chronic Medications

MedStar Family Choice covers a 90-day supply of most chronic medications at retail pharmacies. To start the process, simply send a prescription to the retail pharmacy for a 90-day supply. A full listing of medications available with a 90-day supply can be found below.

MedStar Family Choice members can also sign up for mail order pharmacy for chronic medications. A 90-day supply will be provided to members using mail order services. To start the process, prescribers may call CVS Caremark Mail Service Pharmacy™ at
800-996-5772 or they may submit a prescription to the CVS Caremark Mail Service Pharmacy™.

For questions about coverage for any medication formulary or non-formulary, please call 800-905-1722, option 2.

Wellness Incentives

MedStar Family Choice cares about your health. It is very important that you and the members of your family get your yearly physical exams. Because we feel your health is so important, we offer incentives to support your wellness screenings. Screening tests and immunizations (shots) are important in keeping you and your family healthy. Without screening tests, you may have a health problem that isn’t found. Don’t worry because MedStar Family Choice is here to help you!

Our dedicated Outreach department can help you and your family with scheduling any of the following appointments with your doctor. Once you or your child completes one of the services listed below, you could be eligible to receive an MFC Incentives Prepaid Mastercard®.

  • Yearly physicals
  • Well Child visits
  • Lead testing
  • Mammograms
  • Pap smears
  • Diabetic testing
  • Prenatal appointments

After completing one or more wellness appointments, you can provide the information via our online voucher form to receive prepaid cards. For prenatal incentives, members must enroll in the Momma & Me program to receive prepaid cards. Once enrolled in the Momma & Me program, members can complete the online Momma & Me voucher form.

For additional information or assistance, please call our Outreach Department at 410-933-2200, option 1.

Universal Prepaid Mastercard
Card is issued by MetaBank®, Member FDIC, pursuant to license by Mastercard International Incorporated. Mastercard is a registered trademark, and the circles design is a trademark of Mastercard International Incorporated. No cash access or recurring payments. Card valid for up to 12 months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.

MedStar eVisit

As a MedStar Family Choice member you are able to speak with a medical professional via video from the comfort of your home by using MedStar eVisit. Our MedStar eVisit providers are available to screen for COVID-19 risk, answer your questions, and help you with what to do if you’ve been exposed to COVID-19.

Click here to learn more about MedStar eVisit and Coronavirus.

Check "feel better" off your list with MedStar eVisit

See a Doctor Online 24/7 at No Cost to MedStar Family Choice Members!

What is MedStar eVisit?

  • MedStar eVisit gives you 24/7 video access to board-certified medical doctors. Making it easy to get the care you need, anywhere, anytime!
  • You can connect with a medical doctor via secured video from your tablet, smart phone, or computer for non-urgent medical conditions.

How does it work?

  • Download the MedStar eVisit app for your iOS (iPhone) or Android device. (Click on the hyperlinked text for your smartphone.)
  • Sign up by creating an account - it takes only a minute.
  • Select from the list of board-certified health care providers (doctors) who are available for consultation.
  • Connect with a doctor within minutes via secure video at home or on the go.
  • Your doctor will consult with you, diagnose, send a prescription, or help you with a referral as appropriate.

What type of conditions can MedStar eVisit treat?

  • Cold or flu-like symptoms
  • Seasonal allergies
  • Sore throat
  • Pink eye
  • Rash or hives
  • Nausea, vomiting, or diarrhea
  • Headaches or migraines Constipation
  • Dry skin
  • Sinus infection
  • Joint or back pain
  • Minor cuts or burns
  • Known urinary tract infections
  • Known yeast infection
  • Tick borne illness (Lyme)

When should I not use MedStar eVisit?

  • You should not use MedStar eVisit if you are experiencing severe flu symptoms and require an in-person evaluation.
  • These symptoms include difficulty breathing or shortness of breath, chest pain or discomfort, dizziness, confusion, severe or persistent vomiting, and/or flu-like symptoms that improve then worsen again.
  • If you are experiencing a medical emergency, please call 911 or visit your nearest emergency room.

How much does MedStar eVisit cost?

MedStar eVisit is available at no cost for all MedStar Family Choice members!

Clinical Appeals Procedures

Provider Appeals

All clinical appeals must be submitted in writing within 90 business days from the date of the adverse determination (denial)/EOB. Send a written request with all supporting documentation, such as clinical documentation. Please include an explanation for appeal (why the provider believes the claim was denied incorrectly) on the Medicaid Clinical Appeal Form or cover letter.

Mail the appeal information to the following address:

MedStar Family Choice
P.O. Box 43790
Baltimore, MD 21236
Attn: Clinical Appeals Department

A provider appeal must include a clearly expressed desire for re-evaluation, with an indication as to why the denial was believed to have been issued incorrectly. An acknowledgement of receipt of the appeal (first and second level) will occur within five business days of receipt. MedStar Family Choice resolves appeals regardless of the number of appeal levels allowed within 90 business days of receipt of the initial appeal.

Second level appeals must be sent to the address listed above within 30 calendar days of the first level appeal notification letter and should also have the Medicaid Clinical Appeal Form attached. The second level appeal is the final level of appeal. Providers will receive a response within 30 calendar days of the receipt of the second level appeal. 

To contact the MedStar Family Choice Clinical Appeals Department, please call 800-905-1722, option 3 or fax 410-350-7435.

Member Appeals

A member (enrollee), authorized representative (e.g. parent, guardian, etc.), or provider (i.e. clinician or facility) acting on behalf of a member may request an appeal that results in financial liability or denied services to a member.

Members must provide written consent for a provider or Authorized Representative to appeal on their behalf via the Provider Permission Form for Member Appeal or any other format. The Appeal Review process begins at the time MedStar Family Choice receives the member consent.

All member appeals must be submitted in writing within 60 business days from the date of the adverse determination (denial). Send a written appeal request with all supporting documentation, such as clinical documentation. Please include an explanation for appeal (why the provider believes the claim was denied incorrectly) on the Medicaid Clinical Appeal Form or cover letter.

Mail the appeal information to the following address:

MedStar Family Choice
P.O. Box 43790
Baltimore, MD 21236
Attn: Clinical Appeals Department

An acknowledgement of receipt of the appeal will occur within five business days of receipt. Member appeals have only one level.

To contact the MedStar Family Choice Clinical Appeals Department, please call 800-905-1722, option 3 or fax 410-350-7435.

Appeals

MedStar Family Choice will accept appeals in writing within applicable time frames. Providers acting on their own behalf are defined as those who dispute Adverse Actions when the service has already been provided to the member and there is no member financial liability. A provider appeal must include a clearly expressed desire for re-evaluation/appeal, with an indication as to why the Adverse Action was believed to have been issued incorrectly that MedStar Family Choice is able to investigate. 

In response to provider requests for an alternative method of submitting appeals, MedStar Family Choice has implemented an electronic process via fax. Click here to learn about the new electronic process for appeals via fax.

Claims Appeals

Additional information is available on the Claims Appeals Procedures website

Clinical Appeals

Additional information is available on the Clinical Appeals Procedures website

Timely Filing Appeals

The following information was compiled to help clarify the documentation required as valid proof of timely filing documentation. When submitting an appeal request of a denial to substantiate timely filing, please include the following:

For paper claim submissions:

  • Submit documentation that the claim was received by MedStar Family Choice including but not limited to FedEx receipt, signature form from the USPS, etc.
  • Copy of Explanation of Benefits (EOB) from primary insurer that shows timely submission from the date the carrier processed the claim.

For electronic claim submissions:

  • Submit an electronic data interchange (EDI) acceptance report. Please note that confirmation of receipt from the provider’s clearing house would not be acceptable.
    • Note: A submission report alone is not considered proof of timely filing for EDI claims. It must be accompanied by an acceptance report.
  • The acceptance report must:
    • Include the actual wording that indicates the claims was either “accepted,” “received” and/or “acknowledged.
    • Show the claim was accepted, received, and/or acknowledged within the timely filing period.
  • Copy of the EOB from primary insurer that shows timely submission from the date the carrier processed the claim.

Provider News

Over-the-Counter Drug Coverage

Take a copy to the pharmacy!

View entire Formulary (medication)

Over-the-counter medicines on this list are covered by MedStar Family Choice. Your doctor should send a prescription to your pharmacy to get one of the over-the-counter medicines payed for by MedStar Family Choice. Refills are permitted. Prescriptions may be written for the State limited 12-month maximum. OTC products covered are restricted to generics when available. Brand names are provided as reference only.

You do not need a prescription for condoms. To get free condoms, please take a copy of this document to the pharmacy counter with you. Pharmacists are often not aware of this benefit and do not know how to complete the process. 

Consumer Report Card

The Maryland Department of Health created a report card to assist enrollees in choosing a Managed Care Organization based on quality scores. The Maryland Department of Health evaluates the activities of all Managed Care Organizations contracted with the state of Maryland that provide care to medical assistance recipients in the Health Choice program. The consumer report card has been developed from HEDIS®* scores, encounter data and member satisfaction survey data.

Performance Report Cards for Consumers

Download Adobe Reader to view report cards. Print PDFs in landscape format for best results.

 2020 | 2019 | 2018 | 2017 | 201620152014 | 2013 | 2012 | 2011

*HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).