How to Complete and Submit the Maryland Physicians Care Provider Appeal Form

To challenge a denied or reduced claim, submit the Maryland Physicians Care provider appeal form — officially the Post-Service Appeal Form — within 90 business days of the date on your Medicaid Remittance Advice, along with a cover letter and supporting documentation. You can file online, by fax, or by mail, and MPC has 90 business days from receipt to issue a final decision.¹

When This Form Is the Right Tool

The Post-Service Appeal Form has one purpose: asking MPC to reconsider a claim it already denied or paid at a reduced amount. Do not use it for first-time claim submissions, corrected claims, resubmissions, or general inquiries.² If the claim was rejected because of a data entry error or missing modifier, resubmit a corrected claim through normal channels instead.

One more boundary worth knowing before you start. Provider post-service appeals cover claim payment disputes only. If the underlying issue is a denial, reduction, or termination of services affecting the patient, MPC handles that as a member appeal with its own process and timelines.³ Filing the wrong form routes your paperwork to the wrong department and burns time you cannot get back.

The 90-Business-Day Deadline

Your appeal must reach MPC within 90 business days of the date printed on the Medicaid Remittance Advice showing the denial or reduction.¹ Maryland regulations confirm the same window, measured from the date of denial.⁴ A late appeal gets rejected on timeliness alone, regardless of the merits. Flag the remittance date the day it arrives.

What the Form Asks For

Every field is mandatory. Blanks delay the appeal or keep it out of the review queue entirely. The form collects three categories of information.¹

Provider Information

Enter your provider name, Tax Identification Number (TIN), and Medicaid Provider Number. The form does not ask for a National Provider Identifier, so don’t substitute one. MPC uses the TIN and Medicaid number to locate your contract. Add a contact name, phone number, and mailing address for the person handling the appeal so MPC can reach your office with questions or the decision letter.

Member Information

List the member’s full name and Medicaid number exactly as they appear on the original claim.

Claim Information

Enter the date or dates of service, the control or claim number from the original submission, the Medicaid Remittance date, and the billed charges for the disputed services. The claim number is the single most important identifier on the form; it links your appeal to the original adjudication record. The online tool asks for both the “MPC Claim Number” and a separate “Doc Control #/Pat. Account #”.² Keep your Remittance Advice or Explanation of Payment in front of you so every number matches.

Documents to Attach

The form itself is a cover sheet. Your case lives in the attachments.

A cover letter explaining why you disagree with the denial or reduction. The online tool requires it as a separate PDF, and even on fax or mail submissions a clear written explanation is more persuasive than leaving the reviewer to piece together your position from records alone.²
The Remittance Advice or Explanation of Payment showing how MPC processed the original claim, including the denial reason codes.
Medical records relevant to the dates of service in dispute when the appeal involves clinical appropriateness. A narrative letter from the treating physician explaining why the treatment was medically appropriate strengthens a medical-necessity appeal considerably.
Referral documentation if the denied services required a referral. Include the completed Maryland Uniform Consultation Referral Form; state law requires carriers that mandate written referrals to accept this standardized form as the sole referral instrument.⁵

Organize everything before you send it. Incomplete packages trigger requests for additional information that extend your wait.

How to Submit

MPC accepts appeals three ways. Whichever you pick, send it to the dedicated appeals department, not the standard claims processing address.³

Online

The electronic tool at providerappeals.marylandphysicianscare.com is the fastest route. Complete the fields, select whether you are filing a first-level or second-level appeal, upload your cover letter as one PDF, and upload all supporting documents as a separate batch. Place supporting files in a single folder before uploading, because uploading one at a time overwrites the previous upload. Attachments must be PDFs. Individual files cannot exceed 100 MB, and the combined upload cannot exceed 256 MB. Do not password-protect any file. You will receive a confirmation email as proof of receipt.²

Fax

Fax the completed form and all attachments to 833-656-0648. Save the transmission confirmation page as proof of delivery.¹

Mail

Send the appeal package to:

Maryland Physicians Care, MCO
Attn: Provider Appeals
P.O. Box 1104
Portland, ME 04104¹

Use certified mail or a tracked service. The 90-business-day clock runs from the remittance date, not the postmark, so leave time for delivery.

What Happens After You File

Maryland regulations require MPC to acknowledge receipt within five business days.⁴ An online confirmation email counts. If you faxed or mailed and have not heard anything within a week, follow up; the package may not have reached the right department.

MPC then has 90 business days from receipt of the initial appeal to issue a final resolution, regardless of how many internal appeal levels it uses.⁴ The decision arrives as a formal letter, either mailed to you or posted in the provider portal. If MPC overturns the denial, state rules require the claim to be paid within 30 days of the appeal decision, and the additional payment will show on your next provider remittance.

Second-Level Appeals

If MPC denies the first-level appeal, you can escalate. The online tool includes a dropdown to select “2nd Level Appeal” at filing.² You have at least 15 business days from the date of the first-level denial to file each subsequent level, and at MPC’s final level the regulations guarantee an opportunity to be heard by the organization’s chief executive officer or designee.⁴

Use the second-level appeal to answer the specific reasoning in the first denial letter. If MPC cited a particular policy or contract provision, respond directly to that rationale in your cover letter with additional evidence or a more detailed clinical explanation.

If the Internal Process Does Not Resolve It

You can file a complaint with the Maryland Insurance Administration (MIA) after exhausting MPC’s internal grievance and appeal process.⁶ File online through the MIA portal at enterprise.insurance.maryland.gov/consumer, or download the Life and Health complaint form and submit it by mail or fax to:

Maryland Insurance Administration
Attn: Consumer Complaint Investigation
Life and Health / Appeals and Grievance
200 St. Paul Place, Suite 2700
Baltimore, MD 21202
Fax: 410-468-2270
Phone: 410-468-2000 or 1-800-492-6116⁶

The MIA advises allowing 90 days for a decision. One boundary to note: State Fair Hearings through the Maryland Department of Health are available to Medicaid members, not to providers directly, so the MIA complaint is the external avenue for provider-side payment disputes.⁷

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Maryland Physicians Care. Provider Appeal Form
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Maryland Physicians Care. Maryland Physicians Care Provider Appeal Form
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Maryland Physicians Care. For Providers – Maryland Physicians Care
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Library of Maryland. COMAR 10.67.09.03 – MCO Provider Complaint Process
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Maryland General Assembly. Maryland Code Insurance 15-119 – Uniform Consultation Referral Forms in General
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Maryland Insurance Administration. File A Complaint
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Maryland Department of Health. Request a Fair Hearing – File an Appeal