In an effort to improve our web-based services, we have enhanced our site with updated features and new services for providers. We will keep you informed as additional improvements are made.
Thomas/Love Settlement Information
CareFirst is working toward providing more information regarding claims processing and physician contracts. Certain disclosures require secure log on through CareFirst Direct. Once logged in, users can click "Thomas/Love" under "What's New" to see information on CareFirst compliance with the settlement. If you do not have access to CareFirst Direct, enroll now.
Visit the Thomas/Love Settlement page for general information on the settlement.
Patient Eligibility and Benefit Enhancements
Request for Coordination of Benefit Information
A COB questionnaire is now available on the eligibility summary screen in CareFirst Direct.
Provider Favorites
CareFirst Direct now offers a new time-saving feature to view benefit details. Users can set up to four frequently used service type searches to save as their favorites for future use. The list is easy to update and saves time in reviewing benefit information.
Look for the “Choose Benefit Search” drop-down menu on the eligibility summary and select “Add/Edit Favorites” then follow the 3-step process to customize your search. Eligibility users can also set their favorites under “Your Profile.” It’s that easy!
Multiple Eligibility
Providers have the ability to review a member’s coverage for all covered plans as well as inquire about the plan that is most appropriate.
Expanded Service Date Search
CareFirst Direct has expanded the patient service date search to 24 months of eligible coverage. The date of service entered must be within the past 2 calendar years for MD, NCA and FEP business.
Update to Pending Out-of-Area Claims
CareFirst Direct has decreased the wait period for out-of-area claims from 14 days to 7 days. A request for a status update will be sent to the member’s Home Plan for claims that are pending 7 days or more.
Out-of-Area Authorization Submission
Facilities can now submit authorizations for out-of-area members through CareFirst Direct. Authorizations will automatically be routed to the member’s Home Plan for processing. Providers will receive a response from the Home Plan indicating the status of the authorization (approved, denied, pending) or a notice if the provider will be contacted in another way.
After logging into CareFirst Direct, select the "Out-of-Area Authorizations" link, which appears on the left side of the page. Here, you can review authorization requests and responses that were submitted for out-of-area members.
Password Resets / Account Lockouts
Contact the Delegated Administrator within your office to have your password reset and/or to unlock your account.
The Center for Provider Education & Training
Visit The Center for Provider Education & Training for access to online learning modules and tutorials. Click Office Staff and review the content under Self Service for information on CareFirst Direct.
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