Frequently Asked Questions (FAQs)

A Managed Care Organization (MCO) is a healthcare organization that works with doctors to ensure Medicaid members get the care they need when they need it. An MCO also works with doctors and healthcare companies to provide or arrange a full range of covered services for members.

We are a Managed Care Organization (MCO). We help people in the Maryland Medicaid HealthChoice program get healthcare.

Medicaid eligibility depends on your income and household size unless you are pregnant. The best way to know if you're eligible is to check if you qualify for Medicaid through Maryland Health Connection and engage with their household income calculator tool.

Call CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD) Member Services at 410-779-9369 or 800-730-8530 (TTY: 711), Monday–Friday, 8 a.m.–5 p.m. Members who don't speak English should call 800-730-8530 to ask for an interpreter.

View the English Member Handbook, Spanish Member Handbook, or call Member Services at 410-779-9369 or 800-730-8530 (TTY: 711), Monday–Friday, 8 a.m.–5 p.m. to request a paper copy.

Log into MyHealth Portal and select Replace an ID card to complete a form. You may also call Member Services at 410-779-9369 or 800-730-8530 (TTY: 711), Monday–Friday, 8 a.m.–5 p.m., to request a Member ID card.

You can use MyHealth Portal to view eligibility, check claim status, see authorizations, replace Member ID cards, update your information and more.

Only share your information with doctors, providers and plans approved by the State, and with people who work with Medicaid, like your State Health Insurance Program (SHIP) or Social Security. If you think someone has stolen your identity or want to learn more, visit our Fraud, Waste and Abuse page.

The Interoperability and Patient Access Rule gives you the right to see your own health data on a 3rd party health app on your mobile phone or computer. This will help you make better decisions about your medical care.

Payer-to-Payer Data Exchange lets you and your representatives ask to move your personal health information from other health plans or managed care organizations (MCOs) to CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD).

To learn more about Interoperability and Patient Access Rule, visit our Data and Privacy page.

As a member of CareFirst CHPMD you have access to the following benefits and services: medical, prescription drug, pregnancy, diabetes management and more. Learn more about how to use them on our CareFirst CHPMD Benefits page.

General dentistry, including regular and emergency treatment, are provided by the Maryland Healthy Smiles Dental Program. For detailed information, please visit the Maryland Healthy Smiles Dental Program page or call 855-934-9812 (TTY:711).

CareFirst CHPMD offers a range of benefits to its members including medication coverage (see Drug List), in-network pharmacy options and mail order options. You can learn more about our pharmacy benefits on our Pharmacy Information page.

CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD) may require providers to get approval before prescribing some drugs and products to make sure the drug or product is appropriate. This is called a prior authorization.

Prior authorization requested by you or your provider may be reviewed by a CareFirst CHPMD pharmacy benefits manager for clinical appropriateness. Obtaining prior authorization is the responsibility of the PCP or treating provider. Members who need prior authorization should work with their provider to submit the required clinical data. You can learn more on our Prior Authorization page.

To add your newborn to your Medicaid plan, you need to report the birth to update your coverage. Log in or create an account at Maryland Health Connection to enroll your baby. You can also call Maryland Health Connection at 855-642-8572 Monday through Friday 8 a.m. to 6 p.m. and Saturday 8 a.m. to 2 p.m., or visit your local health department for assistance.

Maryland operates a Medicaid expansion program called Maryland’s Children Health Program (MCHP). MCHP provides full coverage for doctor visits, dental care, vision care, vaccinations, immunizations, mental health services, prescription medications and substance abuse treatments for children up to age 19. Learn more about MCHP benefits and eligibility.

Each member has a different renewal time period, so look out for reminders from us. You can renew your benefits online at Maryland Health Connection, on the Maryland Health Connection App, over the phone or in person.

Online – Visit Maryland Health Connection to Renew.

By Phone – Call 855-642-8572.

Through the mobile app – Download the free MHC mobile app to renew your coverage.

• Google Play
• App Store

Visit our Renew Your Benefits page to learn more.

You can ask us to review your request again. This is called an appeal. Fill out the Appeals & Grievances Form. Once complete, mail the form to:

CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD)
Attention: Appeals & Grievances Department
PO Box 915
Owings Mills, MD 21117

Learn more about this process on the Appeals & Grievances page.

You can track claims statuses on MyHealth Portal. You can also call Member Services at 410-779-9369 or 800-730-8530 (TTY: 711) to ask for more information.

An appeal is a formal request to have CareFirst CHPMD review and reconsider a decision that affects your coverage or benefits. Most of your services should be covered at no cost, but you may file one if a claim for a medical service or medication is denied, if prior authorization is denied, if coverage for a specific treatment or medication is reduced or stopped, or if you disagree with a bill you get for a service.

Fill out the Appeals & Grievances Form. Once complete, mail the form to:

CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD)
Attention: Appeals & Grievances Department
PO Box 915
Owings Mills, MD 21117

Learn more about this process on the Appeals & Grievances page.

A grievance is a formal complaint about any part of your coverage or the services you get. You may file a grievance if your quality of care is poor, you have problems with CareFirst CHPMD customer service, you have difficulty getting needed services or treatments, or you are unhappy about plan policies and procedures.

Fill out the Appeals & Grievances Form. Once complete, mail the form to:

CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD)
Attention: Appeals & Grievances Department
PO Box 915
Owings Mills, MD 21117

Learn more about this process on the Appeals & Grievances page.

You should call CareFirst CHPMD Member Services at 410-779-9369 or 800-730-8530 (TTY: 711), Monday–Friday, 8 a.m.–5 p.m. A member services representative can help you pick a doctor that is in CareFirst CHPMD’s network.

You may use our Provider Search Tool or call Member Services at 410-779-9369 or 800-730-8530 (TTY: 711), Monday–Friday, 8 a.m.–5 p.m.

You can check our Drug List and learn more about your prescription coverage on the Pharmacy Information page.

CareFirst CHPMD is here to help you get the care you need. Please call Member Services 410-779-9369 or 800-730-8530 (TTY: 711), Monday–Friday, 8 a.m.–5 p.m.

PCPs, also called family doctors, are general or family practitioners. Also, they can be internists, pediatricians, OB/GYNs, certified nurse midwives, physician assistants or nurse practitioners. They will give checkups, medical advice, immunizations and referrals to specialists when needed. If you need to find a PCP, use our Provider Directory or call Member Services at 410-779-9369 or 800-730-8530 (TTY: 711), Monday–Friday, 8 a.m.–5 p.m. and our team members can help you find a provider.

We want to make sure you have a regular doctor available for you to get the care you need. If you need to switch PCPs, call Member Services at 410-779-9369 or 800-730-8530 (TTY: 711), Monday–Friday, 8 a.m.–5 p.m. Members who don't speak English should call 800-730-8530 to ask for an interpreter.

A specialist is a healthcare provider who has had extra training in certain conditions or body parts. Examples of specialists are obstetricians who focus on childbirth, dermatologists who can help with skin conditions, and podiatrists who can help with foot conditions.

Any care that's provided by doctors who treat certain conditions.

Getting into care with a specialist sometimes requires a referral from your PCP. If you are unsure if you need a referral and have questions, call Member Services at 410-779-9369 or 800-730-8530 (TTY: 711), Monday–Friday, 8 a.m.–5 p.m.

Please call Member Services at 410-779-9369 or 800-730-8530 (TTY: 711), Monday–Friday, 8 a.m.–5 p.m. A team member can give you information about your doctor, such as:

• Contact information
• Office locations
• Medical specialty

Here is a link to the forms you may need.

CareFirst CHPMD offers access to a 24/7 nurse advice line, maternity health programs that help you secure nutrition counseling, gift cards, coverage on some over-the-counter medications, vision care, virtual primary care, transportation to non-emergency medical appointments and more. Visit CareFirst CHPMD Benefits to learn more.