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|Carefirst administrators login page||Log into your Enrollee Portal. Find a doctor, hospital or service in your neighborhood. A maintenance outage of this provider portal has changed your login credentials!! Client Code required. Specialty incorrect.|
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You can submit your claim one of two ways:. To ensure you are receiving the most appropriate medication for your condition s , additional information may be required from your doctor before filling certain prescriptions. In those instances, CareFirst will work with you and your doctor to manage the process. To see whether your drug is excluded or requires prior authorization, step therapy or quantity limits, visit the Drug Search page and select your plan year to find your specific formulary.
If the drug does not meet the needs of your particular condition or is excluded from the formulary, your doctor can request an exception with a Prior Authorization Form. To ensure our members have access to safe and effective care, CareFirst reviews new developments in medical technology and new applications of existing technology for inclusion as a covered benefit. We evaluate new and existing technologies for medical and behavioral health procedures, medications and devices through a formal review process.
We also consider input from medical professionals, government agencies and published articles about scientific studies. If you have concerns regarding a decision that adversely affect coverage, such as a denial, a reduction of benefits, or a denial of authorization for services, you may call the Member Services telephone number on the back of your member ID card.
A representative can assist you with resolving the issue or initiating the appeal process. If needed, language interpretation is available. If you would like to review the procedure for filing an appeal, visit carefirst.
For a printed copy, call Member Services at the telephone number on the back of your member ID card. In addition, many members have a right to an independent external review of any final appeal or grievance decision.
Refer to your Evidence of Coverage for more specific information regarding initiating an external review, a final appeal determination or a complaint. If you need language assistance or have questions, call the Member Services telephone number on the back of your member ID card.
Get a Quote. Skip Navigation. Login Register. Have questions about health insurance? Explore our Insurance Basics pages. Need Insurance? Log In or Register. Insurance Basics. We know healthcare can be complicated.
To learn more, choose a topic from the list below. Expand All Collapse All Covered benefits. All of our plans include core health benefits, including: Office visits Maternity and newborn care Prescription drugs Laboratory tests and X-rays Preventive and wellness care Dental and vision for children under age 19 Emergency services Hospitalization Behavioral health and substance use disorder Physical, speech and occupational therapy.
Common non-covered benefits. Finding a primary care provider. Finding a specialist, behavioral health or hospital resource. After office hours or emergency care. Out-of-area care and benefit coverage. How to submit a claim. You can submit your claim one of two ways: Mail your claim form To print and mail your claim form, log in to My Account, select the My Documents tab, choose Forms. Choose the form for your type of claim and fill in the required information.
Then, mail the form using the directions included. If you do not have internet access, you may request a paper claim form by calling Member Services at the telephone number on the back of your member ID card. Submit your claim form online CareFirst also offers online claims submission for medical, dental and behavioral health claims.
From your computer or mobile device, log in to My Account and select Claims. Enter the requested information, upload the required documents and submit. Understanding the review process. The medical review process includes, but is not limited to: Preservice review The preservice review serves as a check to assure that members receive the right service in the right setting at the right time. Requests for review include high-cost, complex inpatient, experimental, cosmetic, and outpatient services.
The preservice review also helps ensure services are provided by in-network providers. Your doctor must initiate your authorization request. Members may receive reimbursement for up to eight over-the-counter COVID at-home tests per covered individual in the household per day period without a healthcare provider order or clinical assessment.
Will I receive a new medical ID card after open enrollment for the plan year? CareFirst Administrators will send you a new ID card for your medical plan, even if you do not change medical plans.
This will come in a plain white envelope. Be sure your mailing address is up to date with your employer to prevent delays in obtaining your new card. CareFirst Administrators has revisited with the Trust some of the benefits we enacted at the height of the pandemic. Providers may collect the appropriate member cost share copay, coinsurance, and deductible for treatment rendered on and after September 1, In keeping with local and federal requirements, the cost share waiver that means no cost to members will continue for the following until further notice:.
Have your member ID handy, as well as the bills, and dates of service for these claims. They should be able to work with you, your provider s , and the claims processing team to resolve these issues for you. I was billed by my provider for expenses I do not think I should have been billed for.
Who should I contact for help with this? If authorizations are required to resolve your inquiry, the Advocate assigned to your case will send you any required authorizations forms electronically. Not all claims generate an EOB. EOBs show you the costs associated with the services you received, including:.
How do I change my address for my benefits through the Trust? Contact human resources or your benefits manager to have your address updated for all of the Trust plans you are enrolled in. How do I find a doctor, hospital, or urgent care center near me? Select one of the search options: Doctors by name, Doctors by specialty, Places by name, or Places by Type. Populate the search field s with your search criteria. Click the magnifying glass icon, or hit the enter key to review a directory based on your search criteria.
How do I request a new medical ID card? Log in to the CFA member portal at www. Click the Request ID Cards tile.
Follow the instructions and click Submit my Request. Need one sooner? Follow the instructions to view and print your ID card. Once your identity is verified, a member services representative will be able to order a new card for you. Prospective Members. Success Stories. HR Administrators. Hit enter to search or ESC to close. CareFirst Administrators. Member Services Contact Frequently Asked Questions.
EOBs show you the costs associated with the services you received, including: Claim Details, each service or procedure from each provider is explained What the provider charged What the allowed charges are this is the contracted amount in which an in-network PPO provider agrees to accept as payment Any non-allowed charges discount or amount billed over the contracted amount for this service What the Plan pays Total covered What you pay summary of Deductibles, copays, and coinsurance.
Provider Login. User ID: Password: Remember me? Need Help Logging In. Create an Account. Reset Password Forgot User ID. CareFirst Direct Eligibility/Benefits and Claims Status will be . WebCareFirst CHPDC is the Washington DC provider of Medicaid and Alliance Benefits. A Managed Care Organization committed to providing preventative services and support to its medicaid and alliance enrollees Enrollees Login. CareFirst (CHPDC) Community Health Plan District of Columbia. Call Enrollee Services () Send an Email. WebEnter the first three letters of the member's identification number found on the BlueCross BlueShield ID card Click 'GO' Type of information being requested: Please select one at a time Medical Policy General Pre-Service Review information If you experience technical difficulties or need additional information, please contact BLUE.