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Providers wishing to participate in the CareFirst BlueChoice provider network and any CareFirst BlueCross BlueShield (CareFirst) provider network are required to submit credentialing information.
To ensure that CareFirst and/or CareFirst BlueChoice obtained correct information to support credentialing applications and made fair credentialing decisions, providers have the right, upon request, to review this information, to correct inaccurate information and to obtain the status of the credentialing process. Requests can be made by calling 877-269-9593 and 410-872-3500.
CareFirst and CareFirst BlueChoice accept the Maryland Uniform Credentialing Form and the Coalition for Affordable Quality Healthcare (CAQH) Universal Credentialing Datasource application.
To avoid confusion and unexpected out-of-pocket expenses for members, all providers in the same practice must participate in the same provider networks.
Maryland Uniform Credentialing Form
The Maryland Uniform Credentialing Form is a state mandated form that is accepted by all health plans in Maryland. The Maryland Uniform Dental Credentialing Form must be completed by dental practitioners in applying for participation in the CareFirst dental networks. Both forms must be completed by a practitioner applying for participation in both the medical and dental networks. A Billing Authorization Form and a Practice Questionnaire must also be completed and submitted with the Maryland Uniform Credentialing Form in order to be considered for participation in the network(s).
The Maryland Uniform Credentialing Form must be:
- updated every time there are changes to information to ensure accurate claims processing and directory information
- filled out every three years for re-credentialing
The Maryland Insurance Administration also allows practitioners to complete their credentialing application via CAQH.
District of Columbia Uniform Credentialing/Recredentialing Provider Application
The District of Columbia Uniform Credentialing/Recredentialing form is mandated by the District of Columbia and accepted by all health plans in the District of Columbia. A Billing Authorization Form and a Practice Questionnaire must also be completed and submitted with the District of Columbia Uniform Credentialing/Recredentialing Provider Application in order to be considered for participation in the network(s).
The District of Columbia Uniform Credentialing/Recredentialing form must be:
- updated every time there are changes to information to ensure accurate claims processing and directory information
- filled out every three years for re-credentialing
The District of Columbia also allows practitioners to complete their credentialing application via CAQH.
CAQH Universal Credentialing Datasource Application
The CAQH credentialing system compiles and organizes comprehensive data from more than 600,000 providers in 23 health plans nationwide at no cost to providers. As a result, providers avoid redundant submission of credentialing information to participating health plans and health care organizations. Only one completed application per provider is needed.
CAQH Universal Credentialing Datasource:
- is compliant with the Maryland and the District of Columbia Uniform Credentialing Form regulations
- streamlines the data collection and submission process into a Web enabled system
- allows you to update your information, so you do not have to fill out a new form every three years
If you are interested in using CAQH's Universal Credentialing Datasource, complete the top portion of the CAQH Provider Data Sheet and fax it to 410-872-4107. You will receive a CAQH ID number that allows access to the online application.
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If you have already completed the application through another CAQH member insurance company:
Then, we can access your data to begin the credentialing process.
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