CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD) works collaboratively with our healthcare providers. We are responsive and committed to building long-lasting, productive relationships with our providers.
We offer:
- Competitive fee schedules
- Efficient claims and care management technology for faster claims payments and authorization approvals
- CareFirst CHPMD provider relations representatives and care managers who provide you with exceptional service at your convenience
Medical Network Application Process
The application process includes two important steps.
- CareFirst utilizes the Council for Affordable Quality Healthcare (CAQH) ProView® solution as our Credentialing Verification Organization. Register with CAQH and log into CAQH ProView®
- Complete the appropriate CareFirst Questionnaire based on your provider type/need.
Your application cannot be reviewed until all steps are completed. The information below includes everything you need to know to complete this process.
Important: If you are an Institutional or Ancillary provider interested in joining our network, please email MDContracting@carefirst.com.
- Document your CAQH Identification Number
- You will need this to complete step 2.
If you are a professional practitioner:
If you need to add a new practitioner to an existing group:
- Log into the CareFirst Provider Portal (CareFirst Direct) to access the Provider Directory Updates and Attestation self-service tool to add a new practitioner to your existing group. For assistance, access this step-by-step guide.
Or select from the following specialties:
You must complete this step and upload all required documentation for your application to be considered complete.
Examples of Information needed to complete a CareFirst Questionnaire (see individual questionnaires for more details):
- Applicable Group Tax IDs and Billing NPIs
- W9, if applying as a new group or solo/individual practice
- A complete list of applicable practitioners, including CAQH IDs or Rendering NPIs
- Electronic copies of licenses and insurance policies
- Medicaid ID (ePREP number)
Keep your Information Up to Date
The CareFirst Provider Directory is the single most used resource available to our CareFirst members. It is where they go to find a doctor to meet their healthcare needs. It is important to you and your patients (future and current) your information in our directory is accurate. If not, patients get very frustrated trying to find a doctor in their time of need.
- CareFirst Directory Data: CareFirst’s self-service tool is not integrated with CAQH ProView. Federal law requires all providers to attest and/or update their directory information at least every 90 days with CareFirst directly. For more information on how to access and utilize CareFirst’s self-service tool, review the Keep your Provider Data Accurate page.
- CAQH ProView Application: Once you are registered with CAQH, please continue to review, and make regular updates any time your credentialing information changes (or at least once each quarter). You will be sent a reminder from CAQH to review, update, and attest your data.