Maryland Physicians Care
Welcome to the Maryland Physicians Care Health Plan page. Here you can download policies and procedures specific to both ordering and rendering providers. These include quick reference guides and information designed to assist you in using RadMD to request and check the status of prior authorizations.
If you have any questions about our programs, please contact your dedicated NIA Provider Relations Manager, Charmaine Everett.
Beginning January 1, 2021, NIA will provide utilization mangement for outpatient rehabilitative and habilitative physical medicine services on behalf of Maryland Physicians Care for members 21 years and older. Services requiring prior authorization include:
- Physical therapy services
- Occupational therapy services
- Speech therapy services
In addition, NIA provides utilization management services for non-emergent, advanced diagnostic imaging services for Maryland Physicians Care. In addition to the procedures that currently require prior authorization through NIA, certain cardiac-related procedures will also require prior authorization beginning January 1, 2021:
- MUGA Scan
- Myocardial Perfusion Imaging (MPI)
- Stress Echocardiography
- Echocardiography (TTE/TEE)
Physical Medicine Program
- Physical Medicine FAQ
- Physical Medicine QRG
- Physical Medicine Provider Education Training PowerPoint
- Physical Medicine Tip Sheet/Checklist
- Recording of Provider Physical Medicine Training
Interventional Pain Management Program
Outpatient Imaging and Cardiac Program
- Cardiac FAQ
- Cardiac Checklist
- Cardiac Tip Sheet
- Cardiac Tip Sheet for MPI vs SE
- Utilization Review Matrix-2022 - Updated 7/1/2022
- Ordering Provider QRG
- Rendering Provider QRG
- Provider Education Training PowerPoint
- Tip Sheet
- Prior Authorization Checklist
- Recording of Provider Cardiac Training
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by program:
Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
- Clinical Guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by NIA
- Click here to view NIA’s Physical Medicine guidelines
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.
Update on COVID-19
Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).