Provider.carefirst.com
Providers & Physicians Home CareFirst Provider
WebThe largest provider network in the region and a commitment to value-based, preventative care for all. Learn more about what partnership means to CareFirst. Learn more with our Professional Credentialing Overview. Learn how we're working to transform healthcare. …
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Quick Reference Guides
WebRequired Documents for Dental Credentialing. Guidelines for Provider Self-Services for Dental Providers. Dental Clinical Criteria. Dental Reference Guide for Required Attachments. BCBS FEP Dental Coordination of Benefits (COB) Guidelines. Membership …
Professional Provider Manual
WebChapter 3: Provider Network Requirements: Administrative Functions. Credentialing. Practice Transformation. Provider Scorecard. Role of the Primary Care Provider (PCP) – BlueChoice Only. Reduction, Suspension or Termination of Privileges. Quality of Care …
Eligibility Help Information
WebIf you have comments or questions, we want to help you. For technical support, call the CareFirst Help Desk at (877) 526 – 8390, Monday - Friday, 7:00 a.m.-6:00 p.m. (Eastern Time). Or, refer to the chart below for more information about provider resources and …
Preventive Service Guidelines for Adults
WebMedical history and physical exam: At the advice of the doctor. Height: At least once with follow-up as needed. Weight: Screen all adults for obesity; body mass index (BMI) recommended at least every two years; doctor may ofer or refer adults with BMI of 30 or …
Behavioral Health Request for Authorization Form
WebUtilization Management Behavioral Health Request for Authorization Form. For all Mental Health (MH) and Substance Use Disorder (SUD) service requests, please complete all fields and attach clinical documentation to support the medical necessity of the service(s) …
Institutional/Ancillary Credentialing Overview
WebProviders have the right, upon request, to review the information used in credentialing decisions, to correct inaccurate information and to obtain the status of the credentialing process. To request this information, call (410) 872-3526. Credentialing information for …
Policies and Procedures
WebPolicies and Procedures The MPRM is organized according to specialty, and in some cases, subspecialty, as follows: 00 Introduction 01 Durable Medical Equipment 02 Medicine 03 Mental Health 04 OB/GYN/Reproduction 05 Prescription Drug 06 Radiology/Imaging 07 …
CareFirst Acquires Trusted Health Plan in Washington, D.C. and …
WebCareFirst has acquired Trusted Health Plan (Trusted), a managed Medicaid plan serving approximately 35,000 members in Washington, D.C. There will be no immediate changes to coverage and services, and members should continue calling their …
Health Insurance Abbreviations & Acronyms CareFirst BCBS
WebAHA. American Hospital Association. AMA. American Medical Association. ASC. Administrative Service Contract or Ambulatory Surgical Center. ASO. Administrative Services Only. View this alphabetical list of insurance abbreviations and acronyms that …
Inquiries & Appeals
WebP.O. Box 17636. Baltimore, MD 21298-9375. All Appeal decisions are answered in writing. Please allow 30 days for a response to an Appeal. IMPORTANT: Do not use a Provider Inquiry Resolution Form (PIRF) to submit an Appeal. Instructions for providers on how to …
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