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How can I get a Maryland Uniform Credentialing Form?
Click here to print a copy of the Maryland Uniform Credentialing Form or request an application by calling Provider Information and Credentialing at 410-872-3500 or 1-877-269-9593 and selecting option 1.
Can I submit the Maryland Uniform Credentialing Form by itself?
No. You must submit a Billing Authorization Form and a Practice Questionnaire with the completed Maryland Uniform Credentialing Form.
What information is required to be submitted with each Maryland Uniform Credentialing Form?
The following items must be submitted with each Uniform Credentialing Form:
- Copy of DEA registration certificate, if applicable;
- Copy of Controlled Dangerous Substance registration issued by the State or District in which you practice, if applicable;
- Copy of current professional license(s);
- Copy of ECFMG certificate, if applicable;
- Copy of specialty board certification, if you are board certified;
- If you are not board certified, proof of eligibility, such as copy of admission for examination or proof of successful completion of residency program.
- Copy of professional liability coverage certification and must include the limits of coverage, the expiration date, and the name of the provider covered under the policy. Shared limits coverage is not acceptable
Where do I send the completed Maryland Uniform Credentialing Form, Billing Authorization Form and Practice Questionnaire?
Please mail all the required information to:
CareFirst BlueCross BlueShield
Attn: Provider Information and Credentialing, Mail Stop CG-41
10455 Mill Run Circle
P.O. Box 825
Owings Mills, MD 21117-0825
I practice in several different locations, do I need to participate with CareFirst at each location?
Yes. CareFirst requires that providers who practice with multiple provider groups or have more than one office location participate in all practice locations.
For example, if you are in the CareFirst of Maryland Participating and/or Preferred Provider Networks in one practice location, you must be in the same networks at all locations. This helps to avoid confusion and unexpected out-of-pocket expenses for our members.
I already submitted a CAQH Universal Credentialing Datasource application, do I need to complete a Maryland Uniform Credentialing Form also?
No, the Maryland Uniform Credentialing Form requirements are incorporated in the CAQH Universal Credentialing Datasource application.
If you have already completed the application through another CAQH member insurance company, please contact CareFirst's Provider Information and Credentialing Department at 410-872-3500 or 1-877-269-9593. CareFirst will add your name to the roster and access your information on CAQH's Web site.
How should I notify CareFirst if I move my practice, change my office telephone number or change my Tax ID Number?
CareFirst and CareFirst BlueChoice health care providers who need to change their provider information must complete the Change in Provider Information Form.
Print the form and complete the applicable information, including the information regarding accepting new patients (open/close panel). Be sure to include your office letterhead when returning the completed form.
The mailing address is:
CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc.
Provider Information and Credentialing
Mailstop CG-41
10455 Mill Run Circle
Owings Mills, Md. 21117-0825
You may also fax the completed form to: 410-872-4107.
Whom do I call if I have additional questions regarding credentialing and participation?
Please direct calls to CareFirst Provider Information and Credentialing at 410-872-3500 or 1-877-269-9593.
Whom should I call if I have questions regarding claims, benefits, authorizations or referrals?
Click here for phone numbers and claim addresses.
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