Compare Membership Pathways
MDHIN manages two membership pathways—RxDirectCare (pharmacy concierge) and MDDPC (physician direct primary care)—each with tiered options. Pricing here is illustrative; final pricing appears during checkout on RxDirectCare.com or MDDPC.com.
Example Tiers for RxDirectCare
| Feature | Tier 1 | Tier 1 Enhanced | Tier 2 | Tier 2 Enhanced |
|---|---|---|---|---|
| Monthly Price (PMPM) | $45 | $60 | $72 | $85 |
| Concierge Access | ✓ | ✓ | ✓ | ✓ |
| Pharmacy Visits (per year) | 4 | 6 | 4 | 6 |
| POCT Included | — | ✓ | ✓ | ✓ |
| Navigation Tools | Basic | Enhanced | Enhanced | Premium |
| Family/Dependent Add-On | $30 | $40 | $50 | $60 |
| 340B & Specialty Meds Access* | — | — | ✓ | ✓ |
| Behavioral/RTM Options | — | Optional | Optional | ✓ |
* Where available and permitted by program rules.
How Claims Work
- Pharmacies (RxDirectCare): submit to MDHIN via BIN/PCN using MDHIN groups/tier codes and pseudo-NDC/service codes.
- Providers (MDDPC): submit via standard 837/835 using the MDHIN payer code (or through ConnectHIN).
- Use a unique Visit ID per claim and standard coding (e.g., 99202–99215, 99423; 99000 for POCT when applicable). Use Modifier 25 when multiple services occur in one encounter.