guide
Maryland Physicians Care prior authorization: forms and deadlines
Maryland Physicians Care prior authorization requests go on MPC’s 2026 Prior Authorization Form, by fax or online through its provider portal. Maryland Physicians Care (MPC) is a Maryland HealthChoice (Medicaid managed care) organization serving more than 205,000 members, according to its 2026 second-quarter report.
Under COMAR 10.67.09.04, MPC decides a standard request within 2 business days of receiving the necessary clinical information and no later than 7 calendar days from the request. Behavioral health and ABA requests go to Carelon, outside MPC.
“I love how much time Silna saves me. It cuts back the time I spend on so many of my tasks.”Sofie K., Authorization specialist (G2 review)Silna completes the MPC form and follows each request to a decision.Get started
At a glance
- Evolent reviews complex imaging, rehabilitative and habilitative therapy, and spine procedures.
- Oncology requests need an Eviti code before the request.
- Non-participating providers need prior authorization for anything except emergency services.
- MPC reported a median standard decision time of 1 day in 2025.
- MPC is adding electronic prior authorization through 1upHealth.
Who Maryland Physicians Care serves
Maryland Physicians Care is a locally managed care organization owned by Ascension Saint Agnes, Holy Cross Health, Meritus Health and UPMC Western Maryland, according to its About page. It administers health care services to Maryland’s HealthChoice enrollees and was founded in 1996.
The Medicaid prior authorization guide covers how state Medicaid plans are structured.
Reviews MPC hands to Evolent and others
MPC sends some reviews to outside companies, according to the same page.
| Company | Services it reviews |
|---|---|
| Evolent | Complex imaging (MRA, MRI, PET and CT scans) |
| Evolent | Rehabilitative and habilitative therapy, including chiropractic |
| Evolent | Non-emergent musculoskeletal and interventional spine procedures |
| Eviti | Oncology treatment plans |
| Superior Vision | Vision services |
| Maryland Healthy Smiles Dental Program | Dental services |
Behavioral health and ABA go to Carelon
MPC’s prior authorization page sends behavioral health services to Carelon Behavioral Health of Maryland. Maryland Medicaid’s specialty behavioral health services are carved out of managed care. Maryland Medicaid manages them and pays providers directly, and all HealthChoice members work with Carelon, according to the Maryland Department of Health.
In Maryland Medicaid, ABA services are covered and reimbursed by the Medical Assistance fee-for-service program through its Behavioral Health Administrative Service Organization, Carelon Behavioral Health, under the ABA Provider Manual effective February 1, 2026.
Decision deadlines under COMAR and federal rules
Under COMAR 10.67.09.04A, a Maryland HealthChoice MCO decides each type of request within these times.
| Request | Decision deadline |
|---|---|
| Standard | 2 business days after the necessary clinical information arrives, and no later than 7 calendar days from the request |
| Expedited | 72 hours |
| Covered outpatient drug | 24 hours |
Standard and expedited decisions may be extended up to 14 calendar days if the enrollee or provider asks, or the MCO justifies the need for more information. The federal rule for Medicaid managed care sets the same 7 calendar days and 72 hours from 2026, as MPC’s metrics report notes.
In 2025, Maryland Physicians Care reported approving 136,803 of 171,892 standard prior authorization requests for medical items and services (80%) and 822 of 934 expedited requests (88%), with a median decision time of 1 day for both, in its 2025 prior authorization metrics. These figures are insurer-reported.
- 80%
- standard requests approved in 2025
- 1 day
- median standard decision in 2025
For a denied request, see the guide to appealing a prior authorization denial.
How Silna works on MPC requests
Silna checks which codes need approval, submits each request with the documents it needs and follows up until a decision comes back. It is rated 4.8/5 across 66 verified reviews on G2.
“Instead of having to login to several different portals, we only have to use Silna and they take care of the rest.”Kate G., OwnerSilna enters and tracks each MPC request for your team.Get started
Key terms
- HealthChoice
- Maryland's Medicaid managed care program, which MPC administers for its members.
- MCO
- A managed care organization, a health plan that delivers Medicaid benefits under a state contract.
- Evolent
- The company that reviews MPC's imaging, therapy and spine requests.
- Carve-out
- A service, such as behavioral health, that Maryland Medicaid manages and pays directly.
Frequently Asked Questions
Where do I send an MPC prior authorization form?
Fax requests for scheduled inpatient and outpatient services and transplants to 1-800-953-8856, or submit them online through MPC’s provider portal.
Does MPC authorize ABA therapy?
No. Maryland Medicaid’s fee-for-service program covers ABA through Carelon Behavioral Health.
What are MPC’s decision deadlines?
Up to 7 calendar days for a standard request and 72 hours for an expedited one, under COMAR. MPC’s 2025 median was 1 day.
Who reviews imaging for MPC?
Evolent reviews MPC’s complex imaging, including MRI, MRA, PET and CT scans.
This article is general educational information and does not give medical, legal or insurance advice. MPC can change its requirements, so confirm them on its provider site before you rely on this guide.
About the author
Jeffrey Morelli
Jeffrey Morelli is the Co-Founder and CEO of Silna Health, the first Care Readiness Platform built to remove the administrative barriers that delay care. Silna automates benefit checks, eligibility, and prior authorizations across 1,000+ payors, and is backed by $27M from Accel and Bain Capital Ventures. Before Silna, Jeff spent a decade in San Francisco building and scaling products for highly regulated industries, including leading go-to-market at Truework (Series C, acquired by Checkr).
Last updated: November 4, 2026.