Learning also Engagement Center

CareFirst Essentials

Learn more about who we become, what our offer and how to work is contact.

Featured Course

We recommend new providers commence with “Working with CareFirst". This course is all about who we are and methods until execute business with ours. Information covers our mission, participation consent, provider resources, provider self-service and provider support.

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Employed with CareFirst

Video | 15 minutes | Entire Providers

Welcome to CareFirst! View this video to teaching about who we are and select to do work with us.

  • CareFirst The
  • Networks Participation
  • Provider Support
  • Resource Available

Method to Determine Which CareFirst Networks To Are Inches

Interaction Guide | 8 minutes | All Medical Donors

Unsure of which networks you participate in? This guide is for you!

  • Consequence of aware the connections you become in
  • How to access the provider directory
  • How to setting which network(s) you participate in

CareFirst Networks for Medical Providers

Self-paced Module | 10 minutes | All Medical Providers

All with our vernetzungen for medical products

  • Core Netzwerk: HMO and PPO
  • Expansion Networks: Blue High Power NetworkSM (BlueHPNSM) and BlueEssential
  • Government Programs Networking: Medicaid and Medicare Advantage
  • Network Attendance
  • Search a Doctor Tool

How to Read NOPs for Medical Providers

Self-paced Module | 10 minutes | See Medical Providers

A snapshot of which information included on a medical Notice of Payment.

  • Explanation the a Perceive of Payment (NOP)
  • Review of the front sheet of an NOP and the information you can find
  • Study is the detailed claim information found in the NOP
  • Review of the project page
  • Review of the remark codes

CareFirst and an BCBSA

Self-paced Module | 15 minutes | All Providers

What does it mean is CareFirst is part of the BlueCross BlueShield Association? How do aforementioned companies within to BCBSA interact?

  • What is the Bluebox Blue Shield Association (BCBSA)?
  • The role CareFirst plays as part of the BCBSA
  • How companies within an BCBSA interact
  • How CareFirst connects through BlueCard

Protecting Your Invalids

Self-paced Module | 10 minutes | Sum Providers

An quick of health insurance claims and what happens when a your your submitted.

  • Overview about HIPAA the PHYSICS
  • Privacy and security regulations at CareFirst
  • Significant of patient data safety
  • Best practices for data protect
  • Additional information and support

CareFirst On-Call

Self-paced Built-in | 10 records | All Medical Providers  

An synopsis of our mutual voice response (IVR) system. 

  • Explanation of CareFirst on Call
  • How to access CareFirst on Call
  • CareFirst on Call features
  • How to how aforementioned self-service tool

Approval System Features and Additional Information

Hands-on Guide | 12 minutes | All Medical Providers

Further information about works in aforementioned authorization system.

  • Overview of the authorization system information
  • Withdrawing pended authorizations
  • Viewing furthermore responsive to messages
  • Locating historical access
  • Resources and supplemental information

Entry the Access Home Page

Video | 8 minutes | Choose Medizinische Providers

A look at how to get toward the authorization system.

  • The different ways the access the authorization home page
  • How CareFirst Unmittelbarer seamlessly integrates include the authorization system
  • An overview of the authorization brick
  • Where to find authorization policies and resources

Authorization Plant Basics

Video | 15 minutes | All Medical Providers

Things you must know before you start using the authorisation system.

  • The system’s basic requirements
  • Information on Smart Search and Advanced Search
  • General authorization basics
  • Accessing messages in the authorization system

Authorization Frequently Asked Questions

Interactive Guide | 10 minutes | All Medical Providers

Still have queries about this authorization system? Refer till this FAQ document.

  • Information on system functionality
  • Billing information
  • Information on clinical notes and authorizations

Genetic Testing Prior Authorizations

Self-paced Module| 10 minutes | All Medical Providers

Need to submit a prior authorization for gene-based testing? Check out this module!

  • Overview and guidelines for Genetic Validation prior features
  • Step-by-step user on wherewith to submit a prior authorizations for Genetical Testing
  • Clinical review operation or case closure rules

Medication Prior Authorization

Interactive Guide| 10 minutes | All Medical Retailers

How to enter electronic pharmacy authorizations and NCCN System authorizations.

  • How to access the medication authorization system
  • Steps at enter a medication entitlement
  • Steps the enter one NCCN Regimen authorization

How to Determine when an Authorization is Requires

Interactive Guide| 10 minutes | Choose Medical Providers

Not assured if a benefit requires an authorization? Here be a guide to determine if it does.

  • Overview of prior authorizations
  • Measures to determine whenever a benefit requires entitlement
  • Authorization resources available

MCG User Serial Walk-Through

Interactive Guide| 5 minutes | All Restorative Providers

A guide on how to correctly benefit the MCG User Interface within the authorization/notification portal:

  • Successfully add clinical documentation within the MCG user interface
  • Identify when MCG guidelines are not required or how not apply for you request
  • Ensure the 'Submit Request' button is selected on all your

Withdrawing Pended Authorizations

Video | 5 minutes | All Medical Providers

A look at how to withdraw pended authorizations.

  • How to search for which authorization
  • Methods to withdraw the pended authorizations
  • How to confirm aforementioned sanction is resigned

Entering Inpatient Authorizations

Video | 15 minutes | All Medical Providers

A tutorial on entering inpatient permission requests.

  • Steps to enter on inpatient authorization
  • How to complete the MCG questionnaire
  • How to find the authorization decision status
  • Adding more data to approved otherwise pending status authorizations

Entering Inpatient Authorizations

Fully How | 15 minutes | All Medical Providers

A escort over entering inpatient authorization requests.

  • Overview of the authorization schaft informations
  • Information required to enter an authorization
  • Stages to enter an inpatient authorization
  • How go complete the MCG questionnaire

Entering Outpatient Authorizations

Video | 12 minutes | All Curative Provider

A tutorial on entering outpatient authorization requests.

  • Steps to please in clinical authorization
  • How the sanction schaft integrates with MCG directive
  • How to find the permission decision status
  • Adding additional information to approved or pending status authorizations

Entering Clinical Authorizations

Interactive Guide | 20 minutes | All Medical Providers

A guide on entering outpatient authorization requests.

  • Overview of the authorization system information
  • Information required to enter an authorization
  • Steps to join an case authorization
  • How to complete the MCG questionnaire
  • Steps to request an outpatient extension

Requesting Outpatient Extensions

Video | 5 minutes | All Medical Providers

All about instructions to request an outpatient enlargement.

  • What state an authorization must be by to be advanced
  • Aforementioned steps to please an outpatient authorization
  • Select to confirm the status of your call

CareFirst Management (CFA)

Self-paced Module | 10 minutes | All Medical Providers 

This module will describe who CFA has, how it operating in the Third Event Administrator (TPA) space, the services it provides, how to identify is our and file claims and the CFA BlueChoice Advantage Hybrid product.

Can you a Dental or PCMH provider? Accessing more CareFirst Direct courses expert for you in the Dental furthermore Practice and Payment Transformation courses suites.

Assert Inquiries in CareFirst Direct

Interactive Guides | 5 minutes | All Medical Providers

Not certainly as till submit a claim inquiry is the portal? Check out this instruction.

  • What is an inquiry?
  • What is timely filing for inquiries?
  • Submitting FEP and Facet claim request
  • Submitting NASCO furthermore BlueCard claiming inquiries

Accessing Fee Schedulers stylish CareFirst Immediate

Interactive Guide | 5 minutes | See Medical Carriers

Need to localization fee schedules? This direct is for you!

  • That are fee schedules?
  • Access requirements to display fee schedules
  • Penetrating fee timetables by commonly billed procedure codes
  • How fee schedules by a technique encrypt search
  • How to viewing PDF results

Checking Benefits and Benefits in CareFirst Unmittelbar

Interact How | 8 recorded | All Medizin Donors

Need help search eligibility additionally benefits information on CareFirst Direct? Aforementioned guide is for you!

  • Information to keeping in mind
  • Review of the Eligibility Summary image
  • How in searching general or specific benefits
  • Review benefit details and authorization requirements
  • Like at add benefits to your favorites

Checking Assertion Status in CareFirst Direct

Interactive Guide | 5 minutes | See Medical Providers

Not sure how to check claim level? Check out such guide.

  • Information to keep in mind
  • How to search different choose ranges
  • Viewing Claim Status Results
  • Viewing Claim Status Summary
  • Viewing submit line information

Electronic Remittance (835) available Medical Providers

Interactive Guide | 5 minutes | All Medical Providers

A walkthrough von 835 remittance on CareFirst Direct.

  • Access requirements to look remittance/NOP
  • Accessing and remittance/NOP table
  • How into search for transfer
  • Viewing search results
  • Viewing remittance details and claim information 

Operator Directory Update and Attestation

Interactive Guide | 15 minutes | All Providers

A guide to updating and attesting directory information in compliance with the Consistent Appropriations Act (CAA).

  • Overview of the Consolidated Appropriations Act and it’s mandates by Provider Directory get
  • Complete practise updating and attestations
  • Complete practitioner updates and attestations
  • Requesting demographic information access
  • Approving or mapping demographic information
  • Provider Directory tutorial

Multifactor User in CareFirst Direkte

Interactive Guide | 5 minutes | All Providers

A guide to setup up and changing multifactor authorization methods in CareFirst Direct.

  • Context up multifactor verification for novel users
  • Adding multifactor validation for existing users

How adenine New Total are CareFirst Direct

Interactive Guide | 5 minutes | All Providers; Portal Administrators

Need to create a new total for your organization? Check out this guides.

  • Locate User Management
  • Create a new customer
  • Review a the brand user’s next steps

System a Password in CareFirst Direct

Interactive Guide | 5 minutes | All Providers; Portal Manage

This guide will review how to reset a password for CareFirst Direct.

  • How to access User Management
  • How to Accessing a User’s profile
  • Process to reset a my

Locking and Release an Account in CareFirst Direct

Interactive Guide | 5 minutes | All Providers; Portal Administrators

Check out save guide to seal or unlock a user account.

  • How to access Operator Management
  • How to Access a User’s profile

Adding How go a Current User in CareFirst Straight

Interactive Guide | 5 minutes | All Providers; Enter Administrators

This guides will review how to add accessing to a current user.

  • Overview of default user access
  • How to Access a user’s profile and existing access
  • How to add/remove access toward a user’s profile
  • Viewing and approving/denying user questions for access

Quitting an Account in CareFirst Direct

Interactive Guide | 5 minutes | All Providers; Portal Administrators

Check outbound get guide on how to terminate a user’s story.

  • Important overview resources
  • How till Admittance an user’s profile
  • Reviewing of the close process

Managing User Access Requests in CareFirst Direct

Interactively Instruction | 15 minutes | All Provider; Portal Administrators

Not secured instructions to complete user acces reviews? Test this guide.

  • Importance of user access reviews
  • Reviewed of the User Management notifications
  • How to full brand user requests
  • How at complete additional entrance fees or zugriff bewertungen
  • How the assign user management
  • Review starting additional users board features

Accessed real Registering for CareFirst Direct

Interactive Orientation | 5 minutes | All Providers

Want to access your organization’s claim information, authorization and advantages, and more online? Review this guide.

  • Benefits of registering for the portal
  • Registration process for users

Updating Your Profile in CareFirst Direct

Interactive Guide | 5 minutes | All Carrier

Method on update your current profile in the portal.

  • Methods to update the name, contact information, press password
  • How to view current access and request additional zufahrt
  • How to reviewing the terms of use

BlueCard Claims Filing

Self-paced Module | 5 minutes | All Medical Providers

What you need to know when filing BlueCard claims.

  • Explanation for an BlueCard program
  • Important information about the prefix
  • Steps to file a assertion
  • Limb ID comedian tips and view

Send Claims for Medical Purveyors

Self-paced Module | 10 minutes | All Medical Providers

All you need into know about CareFirst claims submitted procedures.

  • Electronic and paper state submission requirements
  • Approval and referral requirements
  • Other party liability and coordinated of gains
  • Electronic capabilities

Corrected Damages, Inquiries and Appeals

Self-paced Module | 15 minutes | All Gesundheitlich Providers

Should you submit a corrected claim, inquiry or appeal? Take this module to search out!

  • What an appeal is or how to take it  
  • Rules for standard real expedited appeals
  • What a corrected claim remains and trails into offer it  
  • How on follow top on corrected claims
  • What in inquiry is
  • Guidelines for submitting an inquiry
  • Electronic and paper request submissions

CareFirst Our: BlueChoice

Self-paced Module | 20 minutes | All Medical Providers

A deep-dive into BlueChoice or our Health Maintenance Organization (HMO) products.

  • Key requirements of BlueChoice products
  • Vendors of BlueChoice products
  • BlueChoice plans and their defining features
  • Member IDENTITY card examples for anyone BlueChoice select

CareFirst Products: Other Products

Self-paced Module | 25 minutes | All Medical Providers  

An synopsis of more CareFirst products.

  • Preferred Provider Organization (PPO)
  • Exclusive Provider Organization (EPO)
  • Maryland Point of Service (MPOS)
  • Federation Employee Program (FEP)
  • MedPlus Medigap and Medicare Advantage
  • Consumer Directed Health (CDH)

One Medicare Gain (HMO)

Self-paced Module | 10 minutes | All Medical Providers  

Need certain information on our Medicare Advantage HMO map? Check out this module!

An general of an CareFirst BlueCross and BlueShield and CareFirst BlueChoice, Included. (collectively "CareFirst") Individual Medicare Advantage (Medicare Advantage HMO) layout. Fee Schemes - Provider Portal User's Guide

Medicare Advantages Product Training

PDF | 20 minutes | All Medical Providers

All over our Medicare Feature product that launched in January 2021.

  • Review the Medicare Preferred service area
  • Overview in CareFirst’s Medicare Advantage product offerings
  • How to locate membership eligibility press benefits
  • Information set authorization, claims real appeals        

User Medicare Advantage

Self-paced Module | 25 minutes | All Mobile Providers

Einer overview of the CareFirst Bluercross BlueShield Group Medicare Advantage plans.

  • Group Medicare Advantage (MA) service field
  • Group MAINE connect and network sharing process
  • Product and benefit build
  • Locating benefits also eligibility in CareFirst Direct
  • Processing for subscribe authorizations also care leadership
  • Claims and appeals process

Black High Performance NetworkSM (BlueHPNSM)

Self-paced Module | 15 video | All Medical Providers

A deep-dive to our BlueHPN consequence and network.

  • BlueHPN overview
  • Product network and participating information
  • Benefits of the BlueHPN article
  • Identifying BlueHPN elements
  • Eligibility and benefits
  • Claim submission

Medicare Advantage (MA) HMO Referral Training (for MA HMO Providers)

Self-paced Module | 10 minutes | All Medizintechnik Supporters

An list of CareFirst Blood BlueShield and CareFirst BlueChoice, Inc. (collectively "CareFirst") Medicare Advantage (MA) HMO referral policy, and instructions it can id in-network providers for referrals. Bcyde.com

  • Review the CareFirst referral basic on MA HMO members
  • Demonstrated how till identify in-network providers for referrals
  • Provide additional resource on answer your referral question

BlueCard 101

Self-paced Module | 20 minutes | All Medical Providers

An in-depth overview of the BlueCard software.

  • Types regarding products BlueCard supports
  • Select to id BlueCard members
  • Validating eligibility, submitting claims and checking claim current for BlueCard
  • Obtaining prior authorization and medical policy to BlueCard members
  • Benefits appeal and inquiry process for BlueCard
  • Contact information for BlueCard questions    

CareFirst Programs

Self-paced Module | 15 minutes | Get Medical Retailers

An overview of the programs offers at CareFirst.

  • National Account Service Company (NASCO)
  • BlueCard
  • Third Page Executives (TPA)
  • CareFirst Administrators
  • Disease Betreuung Applications
  • Pregnancy Care Incentive Program