Thomas/Love Settlement

General Information

CareFirst BlueCross BlueShield (CareFirst) joined with the Blue Cross and Blue Shield Association, other Blue Plans, and state medical societies across the country to settle a national class action lawsuit known as the Love, et al. v. Blue Cross Blue Shield Association, et al, formerly Thomas, et al. v. Blue Cross Blue Shield Association, et al. (Thomas/Love).

The settlement resolved a series of issues between the Blue Plans and physicians concerning claims processing and physician contracts/reimbursement. CareFirst is committed to openness and transparency and to working with our physicians in tackling the major health care issues facing Maryland, the District of Columbia and Northern Virginia.

The following pages provide additional information on CareFirst's compliance with the Thomas/Love settlement:

General Information:

• Address and Procedures for Physician to Return Overpayment (page 5)
• Claim Editing Policies (page 7)
• Clinical Information Submission Requirement (page 8)
• Electronic Services
• Claims Submission Forms
• Physicians Billing for Not Medicallly Necessary, Experimental or Investigational Services 
• Adverse Determination External Review Process  
• Internal Appeals Process for Billing Disputes:
  • BlueChoice Provider Manual
  • Indemnity Provider Manual (page 17)
• External Appeals Process for Billing Disputes:
  • Billing Dispute External Review Process (BDERP)
  • Submit Billing Dispute
• Medical Policy Manual
• Form for Correction of Posted Physician Information
• Provider Directory
• Mental Health Services Authorization Forms:
  • Maryland
  • Virginia/DC

Provider Secure Resources:

Certain information requires secure log-on through CareFirst Direct. Once logged in, click on "Thomas/Love Settlement" to access this information. If you do not have access to CareFirst Direct, please register here. Settlement Information on CareFirst Direct includes:

• Summary of Participating Provider Contract Changes
• List of Standard Pre-Certification Requirements
• Participating Professional Provider Fee Schedules 
  • Please click here for training tutorial