Terms related to Provider Networks
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CareFirst and CareFirst BlueChoice establish and maintain integrated networks of contracted providers to provide healthcare services to covered members. Provider networks support the products that CareFirst and CareFirst BlueChoice offer.
- What is a Network?
- In the health insurance industry, a network is a complement of health care providers who have contracted with an insurer to provide services to members of a health plan. A provider network can be any combination of individuals or organizations - solo physicians or other professional practitioners; group practices; ancillary and institutional providers such as hospitals, skilled nursing facilities, hospice, etc.; even healthcare suppliers.
- Participating Provider
- Any provider who has a contract with CareFirst and/or CareFirst BlueChoice to provide medical services to members of a health plan is called a 'Participating Provider' (PAR). Participating providers are authorized to conduct standard transactions with CareFirst and/or CareFirst BlueChoice.
- Provider Identification Number
- When a provider is approved for network participation, he/she receives provider identification number(s) to use in health care transactions with CareFirst and/or CareFirst BlueChoice. Participation in multiple networks requires multiple contracts. A different provider number is assigned for each network contract.
- National Provider Identifier
- To improve the efficiency and effectiveness of the electronic transmission of health information, the Centers for Medicare and Medicaid Services (CMS) requires that all eligible health care providers obtain and use a National Provider Identifier (NPI) on all HIPAA standard transactions. The 10-digit NPI will ultimately replace your current CareFirst and/or CareFirst BlueChoice provider identification number(s). For detailed information, see National Plan Identifiers (NPI) in the Providers & Physicians area of the CareFirst web site.