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Care Management MedStar Family Choice Care Management Center 8094 Sandpiper Circle, Suite O Baltimore, MD 21236 1-800-905-1722 or (fax) 410-933-2274 Provides authorization for required services and injectables. Fax or mail Maryland Uniform Referral Form to MedStar Care Management Center. Referrals are valid for 180 days.
Claims/Encounter Data Submission MedStar Family Choice Claims Processing Center 10201 N. Port Washington Rd Mequon, WI 53092 1-800-261-3371 Processes claims and encounter data. Resolves claims issues. Claims must be submitted within 180 days. Claims appeals must be submitted within 90 business days from the date of denial. Electronic submission is available directly or via MedAvant. For MedAvant, the MedStar Family Choice Payer ID # is 00243.
Clinics (Regulated Space) MedStar Family Choice Care Management Center 1-800-905-1722 or (fax) 410-933-2274 PCP and OB/Gyn visits in regulated space do not require prior authorization. All specialist visits in regulated space require prior authorization. Refer to the list of services requiring prior authorization to determine if a certain office-based procedure (regulated space) requires prior authorization. All facility based diagnostic services require prior authorization with exception of AFI, amniocentesis, BPP, EEG, fetal fibronectin, fetal stress test and genetic counseling.
Dental Benefits Dental services for children and pregnant women are provided by the Maryland Healthy Smiles Program at 1-888-696-9596. Adult dental is not a covered benefit.
Diabetes and Nutritional Counseling MedStar Family Choice Care Management Center 1-800-905-1722 or (fax) 410-933-2274 Requires prior authorization. Services provided through home health.
DME, Home Health & Soft Supplies MedStar Family Choice Care Management Center 1-800-905-1722 or (fax) 410-933-2274 DME over $1,000.00 requires prior authorization. Soft Supplies over $250.00 per member per month per provider require prior authorization. With the exception of oxygen, any rental equipment >90 days will also require prior authorization. Home Health requires prior authorization.
Eligibility Verification EVS: 1-866-710-1447 The State’s EVS line verifies that a patient is eligible to receive benefits and is active with MedStar Family Choice. Providers enrolled in eMedicaid may also verify eligibility through WebEVS at www.emdhealthchoice.org.
Hearing (Audiology) Not a benefit for over 21 yrs. Refer member to ENT. Under 21 yrs is managed by DHMH.
Infertility Not an MedStar Family Choice benefit
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Injectables & Infusion Drugs MedStar Family Choice Care Management Center 1-800-905-1722 or (fax) 410-933-2274 Some drugs require prior authorization via MedStar Family Choice Care Management.
Laboratory LabCorp 1-800-788-8765 Requesting physician sends patient to an approved LabCorp draw station using a LabCorp Requisition Form with MedStar checked off.
Mental Health Benefits ValueOptions 1-800-888-1965 Members may self-refer to a participating provider or provider may initiate referral by calling mental health provider.
Orthotics & Prosthetics MedStar Family Choice Care Management Center 1-800-905-1722 or (fax) 410-933-2274 Orthotics totaling greater than $250 per member per claim require prior authorization. All prosthetics, foot orthotics and custom shoes require prior authorization.
Outpatient Rehab (PT, OT, ST, Chiro.) MedStar Family Choice Care Management Center 1-800-905-1722 or (fax) 410-933-2274 Requesting Physician completes written referral to a participating Rehab site. More than 10 visits require prior authorization.(State manages patients under age 21 for PT,OT,ST.)
Outreach MedStar Family Choice Care Management Center 1-800-905-1722 or (fax) 410-933-2264 Outreach verifies PCP assignment, answers questions about benefits, arranges access for non-emergency transportation to medical appointments for MedStar Family Choice members and can assist providers in required outreach attempts for preventive care and member compliance.
Provider Relations MedStar Family Choice Provider Relations 8094 Sandpiper Circle, Suite O Baltimore, MD 21236 410-933-3069 or (fax) 410-933-3077 Assists provider and staff in problem solving, orientations, training, recruitment and credentialling.
Radiology MedStar Family Choice Outpatient Radiology Network (see Provider Manual) Requesting Physician completes a script or MD uniform referral form to a participating radiology site for any radiology tests. Exception: MedStar Family Choice uses an exclusive network for Nuclear Cardiology.
Substance Abuse Benefits ValueOptions 1-800-496-5849 Members may self refer to a participating provider or the provider may coordinate care.
Vision Benefits Allied EyeCare/Advantica 1-866-425-2323 Members may self refer to a participating provider for routine vision care. Medical eye problems must be referred to an approved ophthalmologist.
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