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.
Set a kind to expands:
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
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
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
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
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
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
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
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
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
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
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)
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
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
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
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
