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12/13/2012 Prior Authorization Form MARYLAND PHYSICIANS CARE (MEDICAID) (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign
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How to fill out Maryland Physicians Care:

01
Obtain the Maryland Physicians Care application form either online or by visiting a local Maryland Physicians Care office.
02
Fill out the application form accurately and completely. Provide all necessary personal information, such as your full name, address, contact information, and date of birth.
03
Provide information regarding your household, including the number of people living with you, their names, and their relationship to you.
04
Include details about your employment status and income. This may include providing information about your current job, employer, and monthly income.
05
Indicate any additional sources of income or assistance, such as child support, disability benefits, or government programs.
06
If applicable, include details about your current health insurance coverage, including the name of the insurance provider and policy number.
07
Sign and date the completed application form.
08
Submit the application form along with any required supporting documents, such as proof of income or residency, to the Maryland Physicians Care office either by mail or in person.
09
Keep a copy of the completed application form and any supporting documents for your records.
10
Wait for a response from Maryland Physicians Care regarding the status of your application.

Who needs Maryland Physicians Care:

01
Individuals who reside in Maryland and are in need of affordable healthcare coverage.
02
Maryland residents who meet the eligibility criteria for Maryland Physicians Care, such as income and household size requirements.
03
Individuals who do not have access to employer-sponsored health insurance or other public health insurance programs.
04
Those who are unable to afford private health insurance plans but still require necessary medical services.
05
People who prefer a managed care program that offers comprehensive healthcare services at a reduced cost.
06
Maryland residents who may be eligible for Maryland Physicians Care due to their age, pregnancy, or specific medical conditions.
07
Individuals who value the benefits provided by Maryland Physicians Care, such as access to primary care doctors, specialists, preventive care, prescription drugs, and hospital services.
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Maryland Physicians Care is a managed care organization that provides health coverage to Medicaid recipients in Maryland.
Healthcare providers who participate in Maryland Physicians Care network are required to file claims for services provided to patients.
Providers can fill out Maryland Physicians Care claims electronically through the MAPIR (Maryland Access Point to Health) online portal or by mailing in paper claim forms.
The purpose of Maryland Physicians Care is to provide cost-effective and quality healthcare services to Medicaid recipients in the state.
Providers must report patient demographics, services provided, diagnosis codes, and billing information on Maryland Physicians Care claims.
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