MedStar Family Choice-DC 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-DC 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. Reappointment must be completed every two years from the date that physician privileges are approved by the Board of Trustees. Medical Staff Services Department Our Claims department is available at800-261-3371, Monday through Friday, 8:30 a.m. to 5 p.m.Click here for Claims Status/Online Claims Look Up information. provider portal or to obtain login information 855-222-1043 MedStar Select Member Services For TTY:MedStar associate inquiries 855-242-4872 Quick Reference Guide (PDF) MedStar Family Choice Provider Portal MedStar Family Choice includes Maryland Medicaid and DC Medicaid THIS IS NOT A CLAIMS PORTAL. For Non-Pharmacy requests, use the Prior Authorization (Non-Pharmacy or Opioid) Request Form or Uniform Consultation Referral Form, and fax to us at 202-243-6307. Reappointment applications are mailed at the beginning of March in the reappointment year. Integrated Medicare-Medicaid Long Term Care plan. When registering as a new user, please keep the following points in mind: A pledge from the Practitioner to provide continuous care for his or her patients and to abide by the Hospital policies and Code of Conduct. A claim is a request from a patient or provider presented to an insurance company for payment for services performed. The Board of Directors makes the final decision on all reappointments. To request specific utilization management criteria or to speak with a MedStar Family Choice District of Columbia (MFC-DC) Reviewer or Medical Director please contact us during our normal business hours (8 a.m. to 5:30 p.m.) at 855-798-4244 or 202-363-4348. Healthcare Provider | Maryland, DC, Virginia | MedStar Health Resources for healthy living and caregiving. Our Claims department is available at 800-261-3371, Monday through Friday, 8:30 a.m. to 5 p.m. Click here for Claims Status/Online Claims Look Up information. Leonardtown MD 20650. myMedStar is a free, secure online patient portal where you can keep track of your health information 24/7. Baltimore, Maryland 21218. Email: blegrand@medstarmontgomery.org Affiliation Verifications and Good Standing Letters Note: Information contained in the quick reference guide supersedes the information in the handbook supplement pertaining to eligibility, authorizations, claims, appeals, complaints and grievances. Claims Information and Resources. For navigation and additional myHR support, the HR Solution Center is available to assist at 855-674-myHR (6947). If the service requested is denied, information on how to request an Appeal is included in the denial letter. Looking to become a Magellan Health Provider? Attn: Peggy Thomas View Provider Resources Claims, Appeals, and Grievances If you do not choose an MCO, the State will automatically assign you to an MCO. Those that go through the Department of Human Services (DHS) for their Medicaid eligibility: Call Maryland Health Connection at 1-855-642-8572; or. Please refer to the specific hospital information below for credentialing information. Please be sure to keep all demographic information, including email address, up-to-date with the Medical Staff Office by calling 202-877-5423. This site is for MedStar Family Choice participating Providers. Provider Portals Looking for Magellan Health Provider resources? Per the Bylaws, a Practitioner (MD, NP, Psychologist, DPM, DDS, DMD, LSCW) who wishes to apply for privileges and become a member of the Staff at MedStar Georgetown University Hospital shall establish that he or she meets the following qualifications: Staff membership shall not be denied to a Practitioner on the basis of gender, gender identity, gender expression, sexual preference, sexual orientation, race, ethnic/national identity, language, culture, color, creed, national origin, age, marital status, religion, socioeconomic status, type of procedure or patient in which the provider specializes in, and/or physical or mental disability unrelated to the effective delivery of patient care at the generally recognized professional level of competence. Consent from the Practitioner for inspection of all records and documents pertinent to his or her licensure, training, experience, current competency, and health status, and agreement to appear for an interview if requested. MedStar Union Memorial meets all federal, state and regulatory standards for credentialing and privileging. To obtain an application for MedStar St. Marys Hospital privileges, please contact the Medical Staff Office at MedStar St. Marys Hospital for an Application Request Form (ARF) and submit a copy of your CV to the Medical Staff Office. Please notify the Medical Staff office of any change in home or office address, telephone or email. The reappointment process must be completed every two years from the date that the provider's privileges are approved by the Board. Physician and Provider Resources - MedStar Family Choice Support Welcome MedStar Family Choice-DC Providers, Preauthorization & Utilization Management, Non-Pharmacy & DME Prior Authorization Request Form (PDF), Prior Authorization/Non-Formulary Medication Request Form (Non-opioid, Hep C, or Synagis), Prior Authorization (BH SUD) Request Form, Prior Authorization/Non-Formulary Medication Request Form, Department of Health Care Finance (DHCF) portal, Notice of Nondiscrimination and Language Accessibility. The Medical Staff offices for MedStar Good Samaritan Hospital and MedStar Union Memorial Hospital are now centrally located on the MedStar Union Memorial campus. Healthcare Transformation In order to obtain additional required forms or for questions, please contact the Medical Staff Affairs Office at 202-444-3011. Explore Opportunities For researchers ePREP Provider Portal Reappointment must be completed every two years from the date that physician/allied health professional privileges are approved by the Board of Trustees. Negative drug screen and acceptable criminal background check, Proof of current influenza vaccination (during the defined influenza period). Maryland Medicaid Renewal is NOT automatic this year. The Office is open Monday through Friday from 8 a.m. to 5 p.m. Provider Welcome: 01 To apply for privileges at MedStar Montgomery Medical Center, please complete the following steps. Email: peggy.thomas@medstar.net. CAQH ProView - Sign In 2022 Magellan Health, Inc. All Rights Reserved. 25500 Point Lookout Rd. Physicians whose last names begin MZ are reappointed during odd years. Maryland HealthChoice Providers | MedStar Family Choice This is your gateway to the digital tools, policies, guidance, and materials you and your staff need to deliver high-quality service to your patients and clients in our health plans. The Office is open Monday through Friday from 8 a.m. to 5 p.m. This provider alert provides general guidance on how to register for access to the MedStar Family Choice (MFC) Provider Portal. MedStar Family Choice includes Maryland Medicaid and DC Medicaid THIS IS NOT A CLAIMS PORTAL. Find out the guidelines for timely . NW Inpatient days that do not meet medical necessity as outlined in above criteria are the responsibility of the inpatient facility. A claim is a request from a patient or provider presented to an insurance company for payment for services performed. American Society of Addictive Medicine ASAM utilization management criteria are used per plan benefit. MedStar St. Marys Hospital TTY users, call: 711. All checks are made payable to Visiting Staff Fund. MedStar Family Choice-DC provides notice of the appeals process in a culturally and linguistically appropriate manner. Search for doctors, specialists, and other providers. All non-formulary requests are reviewed by a Medical Director. This site provides secure online services for Maryland Medicaid Providers where you can verify recipient eligibility, obtain payment information and Remittance Advice (RA). Magellan Behavioral Health providers, Join our network, check member eligibility, submit and check claims and find important information and more. MFC-DC's utilization management decision making is based on the medical necessity of the service and the existence of Managed Care Organization enrollment and coverage. Don't have an account? MedStar Provider Appeals, PO Box 269, Pittsburgh, PA 15230-0269; Any appeals submitted after January 1, 2022, should be submitted to the following addresses: . Ensure that the healthcare organizations you authorize have instant access to accurate, timely information. 201 E. University Pkwy. State-of-the-art imaging modalities and innovative treatments. MedStar Family Choice created a Claims Payment Dispute Form. Call Maryland Health Connection at 1-855-642-8572. Our Claims department is available at800-261-3371, Monday through Friday, 8:30 a.m. to 5 p.m.Click here for Claims Status/Online Claims Look Up information. Washington, D.C., 20010. Messages received outside of normal business hours will be addressed the following business day. MFC-DC can take an additional 14 days to make a final decision if the provider or enrollee requests an extension or if MFC-DC determines an extension is in the best interest of the enrollee. Please do not register on this site if you are NOT a Provider. Click here for more information regarding claims payment disputes. Click here for more information and resources regarding appeals. Agreement of the Practitioner to comply with the Ethical Religious Directives in regard to matters involving pastoral care, patient care, care for the beginning of life, and care for the dying on the Hospital clinical campus. Customized care tailored to individual patient needs. New User Request? In accordance with the Emergency Medical Treatment & Labor Act (EMTALA), MFC-DC will pay claims for all medical screening examinations (MSE) when the request is made for examination or treatment for an emergency medical condition (EMC), including active labor. Complete the form you received in your enrollment toolkit and mail in. Pages - Home - Maryland Department of Health Please use one or more of the fields below to begin your search. Agreement of the Practitioner to release and waive any claim against the Hospital, its Staff members, employees, and Board members, and any other individual, institution, or agency acting at the request of the Hospital for: (i) providing information to the Hospital as part of the credentials review process; (ii) participating in the credentials review process or in a Professional Review Action; or (iii) providing information to another hospital, institution or agency in good faith, in response to a request for credentials or performance information about the Practitioner. Current licensure in the District of Columbia, Maryland or Virginia, as required to render patient care services at MedStar Georgetown, or another MedStar Health hospital or one of its ambulatory care satellites. Click here for more information and resources regarding claims. For enrollees with urgent authorization needs, physicians or a physicians staff member should contact MFC-DC Clinical Operations Department at 855-798-4244. Support This program is funded in part by the Government of the District of Columbia Department of Health Care Finance. Please contact the office at 301-877-4536 for any assistance or questions. We accept CAQH uniform application for initial appointment. Follow this link, if you wish to access the VNS Health physician web portal. Register for Provider Emails Why CareFirst? If a physician feels it medically necessary to prescribe a medication not on the formulary, the physician may submit this request to MFC-DC for prior authorization. Medical Staff Office A Reset font size. Monday-Friday, 8 am-5 pm. Magellan Behavioral Health Providers Notify the Medical Staff Office of any change in home or office addresses, as well as telephone numbers. Register Today! We are a local health plan owned by MedStar Health. 3001 South Hanover St. For PCA Requests: Submit the electronic prescriber order form (ePOF) along with necessary medical records/clinical information for the date of service via Department Healthcare Finance (DHCF) portal. Find resources for caregiving and healthy living. MedStar Family Choice- Maryland Providers, Become a Credentialed Provider in Maryland. Click here for Claims Status/Online Claims Look Up information. Previously registered myHR passwords are no longer valid. Reviewers and Medical Directors are also available to discuss any and all utilization management decisions, questions, or issues. Office of Medical Staff Affairs MFC-DC pays for a wide variety of medications, as outlined in our formulary. MedStar Family Choice recognizes the right of a member (enrollee) and/or authorized representative or providers (i.e. MFC-DC allows up to fourteen (14) days to process non-urgent authorization requests. Associates requiring assistance with their MedStar Network Credentials, including password resets, should contact the IS Help Desk at 877-777-8787. 800-261-3371, available Monday through Friday, 8:30 a.m. - 5 p.m. Claims and Billing Procedures. 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. Effective January 1, 2023, MedStar Family Choice will have a new provider portal in place to view claims: https://mfcmdprovider.healthtrioconnect.com Please be advised you will need to enroll in this new provider portal. Medical Preauthorization Process, Forms | Maryland - MedStar Family Choice ATTN: Cathy Oliver Please Enable Location Services in Your Browser Settings to Continue. Review Provider Relations Territory Assignments View Provider Resources Claims, Appeals, and Grievances If you are experiencing a medical emergency, please call 911 or seek care at an emergency room. Updated licensures, malpractice coverage/issues, and special certifications, Medical staff member status or resignation. Provider OnLine | MedStar Provider Network Click "Sign In" As a reminder, your MedStar Network Credentials are the same as those you use daily to log into your work computer, access PeopleSoft, and/or clock in through MedStar MyTime. Utilization Management - MedStar Family Choice-DC | Providers Contact Us. Learn more about what partnership means to CareFirst. Credentialing Department MedStar Family Choice-DC recognizes the right of a member (enrollee) and/or authorized representative or providers (i.e. Providers must complete the form in its entirety and submit all necessary documentation. Reappointment applications will be sent to Medical Staff members via email six months prior to the expiration of the appointment. Each MedStar Health hospital has its own requirements. A Increase font size. Check our schedule to find a class that interests you. PO Box 527 Log In - MedSTAR Learn how to register as a Provider using our new MedStar Provider Portal. Medical Staff Services is responsible for verification of healthcare providers education, training, licensure, work experience and competence in performing specific procedure patient care responsibilities. Convenient locations across Maryland, DC, and Northern Virginia. See Provider Quick Links to access more information and resources. MFC-DC requires and fully reviews emergency department clinical documentation for evidence of a medical screening exam, prudent layperson guidelines, as well as evaluation of assigned treatment levels based on reasonable clinical care time guidelines. The list is included in the MFC-DC Provider Manual. Our experienced clinical staff reviews all requests. Pages - Provider Information - Maryland Department of Health 201 E. University Pkwy. MedStar Union Memorial Hospital has established mechanisms and professional criteria for appointment and reappointment of its medical staff members as well as for granting and reviewing hospital-specific clinical privileges. Reappointment applications are sent to provider offices four months prior to the expiration date. Medstar Laboratory Looking to become a Magellan Health Provider? If the applicant meets minimum criteria as defined in the Medical Staff Bylaws, an application packet will be sent via email. For Pharmacy requests only, use the Prior Authorization/Non-Formulary Medication Request Form, and fax to us at 202-243-6258. Physicians may call MFC-DC at 855-798-4244. All rights reserved. All applicants for medical staff membership, clinical privileges, or information on how to proceed with applying must contact Bethany Legrand, Director of Medical Staff Services. Our Claims department is available at 800-261-3371, Monday through Friday, 8:30 a.m. to 5 p.m. Click here for Claims Status/Online Claims Look Up information. Find a Doctor Find the best doctors in your area. Washington, D.C., 20007. MFC-DC reserves the right to direct services to participating providers and facilities.

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