Forms - Provider Services - CareFirst BlueCross BlueShield

Forms

Provider Forms

Please choose the form you wish to view from the table below:

Administrative

CareFirst BlueChoice Referral Form

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Change in Provider Information

Please submit letterhead with this form.

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Provider Inquiry Resolution Form

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Medical

Authorization Form for Information Release

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Authorization Form for Information Release

For use with Magellan - Maryland

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Authorization Form for Information Release

For use with Magellan - DC and Virginia

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Durable Medical Equipment Authorization

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Home Care Authorization

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Home Care Extension Request

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Hospice Authorization

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Hospice Extension Request

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Infertility Pre-Treatment Form

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Infertility Treatment Extension Form

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Infusion Therapy Authorization

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Infusion Therapy Extension Request

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Outpatient Pre-Treatment Authorization Program: Initial Authorization Request

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Outpatient Pre-Treatment Authorization Program: Re-Authorization Request

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Physician Request Form for Synagis®

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Precertification Messages Request

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Pre Service Review Request for Authorization Form

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Transition of Care

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Mental Health/Substance Abuse

Maryland Uniform Treatment Plan Form

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District of Columbia Treatment Plan Form

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Claims

Professional Provider Claims

Important information on the CMS Web site.

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Institutional Provider Claims

Important information on the CMS Web site.

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Dental Claims

Providers can order the most current version of the required claim form from the American Dental Association.

order form

Credentialing

MD Uniform Credentialing

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CAQH Provider Data Sheet

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Billing Authorization Form

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Click here for more information about the credentialing process.

Requires Adobe Acrobat Reader, which can be downloaded free from the Adobe site.

Need Claim Status or Eligibility?

Phone Numbers and Claim Addresses

Provider Manuals

Find a Doctor

Find My Provider Representative - Professional, Ancillary & Institutional, Dental

Credentialing

Update Practice Information PDF

Thomas/Love Settlement

Disease Management

Center for Provider Education & Training

Pay for Quality Programs:

	CareFirst Quality Rewards - Surgeons
	CareFirst Quality Rewards

National Provider Identifiers (NPI)

Options Discount Program - Alternative Therapies, Vision, Hearing and More

Health and Wellness -
My Care First (En Español)

HIPAA

	General Information Manual Update
	NASCO Referrals
	New State of Maryland Health Plan Options
	Voucher Communication for FEP Dental Providers - Alert Reminder
	Enzyme Replacement Codes Policy Change
	FACETS Migration Continues
	Updates to CareFirst General Information Provider Manual
	Receive News Via E-mail
	Prescription Drug News
	Nutritional Supplements and Over-the-Counter FDA Safety Information
	Newsletters
	Latest News & Archives

	Serving Maryland, the District of Columbia and portions of Virginia. CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueChoice, Inc., an affiliate company, also offers health benefit products and services on this site. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®' Registered trademark of CareFirst of Maryland, Inc.
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