COVID-19 Updates

The following is a listing of recent updates and changes made by MedStar Family Choice in response to the Novel Coronavirus (COVID-19).

COVID-19 updates for MedStar Family Choice providers:

NOTE: Maryland Poison Center has issued their ToxTibits newletter regarding the dangers of chloroquine and hydroxychloroquine medications for treatment of COVID-19.

For additional resources, please visit the Resources for Health Care Professionals on Maryland.gov. Scroll down to the Medicaid heading for the appeals extension, authorization update, teleheath and telephonic services guidance.

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!

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. 

Emergency Room Auto-Pay List

For the ICD-10-CM version of the Emergency Room Auto-Pay List effective for dates of service starting on March 12, 2020 (which incorporates the ICD-10 code additions and deletions), please click here for a copy of the list

Please note that claims for emergency services with a primary ICD-10-CM diagnosis code on the auto-pay list will be paid without further documentation for the appropriate dates of service.

MedStar Family Choice reserves the right to audit claims in accordance with Maryland regulations for consistency between clinical documentation and information presented on the bill (including the reported diagnosis).

If you have any questions about the auto-pay list, please contact our Provider Relations department at 800-905-1722, Monday-Friday between 8:30 a.m. - 5:00 p.m.

Claims, Appeals, and Grievances

Claims, Appeals, and Grievances

Claims

A claim is a request from a patient or health care provider presented to an insurance company for payment for services performed. Click on the hyperlinked Claims heading above for more information and resources regarding claims.

To obtain information on the status of your claims, please log on to the online claims look up website or call the Provider Customer Service Line at 800-261-3371. Our Claims Department is available Monday through Friday 8:30 a.m. – 5 p.m. Click here for more information on Claims Status/Online Claims Look Up.

A new feature for the online claims look up is that each office will initially register for a master account and then register all other users in their office as subaccounts. Subaccounts will allow multiple users to share the same web portal access without sharing the same user name and password. The employee who is registered as the master account will be responsible for activating and deactivating employee logins. If your office doesn't already have an account, you may also register to obtain online claims statusClaims compliance information is available here.

Appeals

MedStar Family Choice recognizes the right of a member (enrollee) and/or authorized representative or providers (i.e. clinician or facility) to request an Appeal of an Adverse Action (denial) that results in member financial liability or denied service. MedStar Family Choice reviews all appeal requests of Adverse Actions and resolves appeals in a timely, appropriate manner. MedStar Family Choice provides notice of the appeals process in a culturally and linguistically appropriate manner. Methods of informing members and providers about this process include articles in the newsletters, and sections in the member handbook and provider manual. Click on the hyperlinked Appeals heading above for more information and resources regarding appeals.

Grievances

MedStar Family Choice maintains a process for recording and triaging Grievances and Appeals of Grievance resolutions so that they may be resolved in a manner that is consistent with MedStar Family Choice service standards, that is responsive to the needs of members and providers, that meets or exceeds State and regulatory standards and that permits tracking and reporting. Contact Member Services at 888-404-3549 for more information.

Recent Formulary Changes

The following is a listing of recent formulary changes made at MedStar Family Choice Pharmacy & Therapeutics Committee meetings. Please note that the formulary link is updated quarterly, whereas these updates occur every two months. In order to make sure you are viewing the most up to date information, please refer to the formulary document as well as the most recent update link below: