Maryland Medicaid Policy Update: Key Changes for Primary Care Providers

UnitedHealthcare has issued new policy changes to Primary Care Providers (PCPs) in the Maryland HealthChoice Medicaid program. The changes will streamline provider duties and coordinate caring, so that members get timely and quality healthcare services.

PCP Assignment To Be Made Compulsory

According to HealthChoice program requirements, every member of the UnitedHealthcare Community Plan (Medicaid) should have a PCP. In case a member does not select it, a PCP will be given automatically. The provider assigned will be inscribed on the ID card of the member. Although the members can go to any PCP in the program, UnitedHealthcare will promote the utilization of the same provider to have a centralization of medical records and better care continuity.

Observation of Members and PCP Reassignment Support

The participating providers can treat any member of Medicaid, whether assigned a PCP or not. It is possible to check the eligibility using the Maryland EVS Portal or the UnitedHealthcare Provider Portal.

Members can also make a change to their assigned PCP by calling Member Services at 800-318-8821 (TTY 711), Monday-Friday, 8 a.m. 7 p.m. ET. The PCPs are advised to help the members through the process to ensure their records are updated and the correct provider is listed.

PCP Panel Management

Through UnitedHealthcare Provider Portal, the providers can access their member panel lists, adjust panel limits, and monitor HEDIScare gaps. Review of panels is done once a month to ensure effective management of the capacity of patients.

Specialist Referrals are Needed

It is the role of PCPs to refer to in-network specialists in case of any further care requirement. All specialist visits must be pre-planned to ensure that there is order in treatment pathways.

View the Maryland Provider Manual or contact 24/7 chat on the UnitedHealthcare Provider Portal for more details.