Maryland Medicaid: Primary care provider policy updates

Primary care providers (PCPs) help ensure UnitedHealthcare Community Plan (Medicaid) members receive quality care. While members can see any participating PCP, we encourage them to choose one PCP to manage their overall care and keep all medical records in one place.

PCP assignment 

The Maryland HealthChoice program requires every member to have an assigned PCP. Members must choose a PCP, or one will be assigned automatically. The assigned PCP will be listed on the member ID card.

Seeing members

If you’re a participating health care provider, you may see any UnitedHealthcare Community Plan (Medicaid) member — even if you’re not their assigned PCP. You can check eligibility through the Maryland Department of Health’s EVS Portal or the UnitedHealthcare Provider Portal.

UnitedHealthcare members can request to change their assigned PCP by calling Member Services at 800-318-8821, TTY 711, Monday–Friday, 8 a.m.–7 p.m. ET. UnitedHealthcare Community Plan requests that PCPs assist the member in this change, so the correct PCP is reflected on their member ID card.

Provider panel roster

You can view your UnitedHealthcare Community Plan (Medicaid) panel roster assignments, member contact information and HEDIS® measures/gaps in care, and update your PCP panel limits in the portal. The PCP panel is monitored monthly to help manage capacity.

Referring members to a specialist

If a member requires care from a specialist, PCPs are responsible for generating referrals to network specialists and coordinating a member’s care prior to the member seeking further care with any network specialists.

To learn more, please view our specialist referral requirements.

Questions? We’re here to help.

For more information, see the Maryland Provider Manual or connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.