Claims for CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD) members may be submitted in one of the following methods:
Electronic Data Interchange (EDI) Claims
Electronically (preferred method) through the Availity Clearinghouse. Providers can obtain additional information about submitting claims through Availity by calling 800-282-4548 or visiting the website at Availity Essentials Provider Portal.
Mail paper claims to:
CareFirst BlueCross BlueShield Community Health Plan Maryland
PO BOX 14362
Lexington, KY 40512
All claims, whether paper or electronic, should be submitted using standard clean claim requirements including, but not limited to:
- Member name and address
- Member ID Number
- Place of Service
- Provider Name
- Provider NPI
- Diagnosis (ICD10) code(s) and description(s)
- Applicable CPT/Revenue/HCPCS codes
- Applicable modifier(s)
Claims must be filed within 180 calendar days of the date of service or 180 calendar days from the date the primary insurance paid.
If you would like additional information relative to CareFirst CHPMD's claims submission guidelines, please refer to the Provider Manual.
Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)
CareFirst CHPMD offers ePayment which replaces paper-based claims payments with electronic fund transfer (EFT) payments that are directly deposited into your bank account. Once enrolled you will be able to search, view and print images of the Electronic Remittance Advice (ERA) or download HIPAA formatted 835 ERA files to simplify payment posting.
To enroll, contact a Zelis Provider Enrollment Advisor today at 855-496-1571 and reference code 4124 or visit zelis.com/providers/provider-payments for more information.
Claims Disputes
A provider dispute is a request for a post-service review of a denied claim. There are three types of provider disputes:
- Claim Dispute: Request for review of a denied or underpaid claim.
- Reconsideration: Request for reconsideration of CareFirst CHPMD’s decision based on new or additional information.
- Resubmission: Request for review of denial or payment amount because of incorrect coding or missing information.
Submit all disputes using the Post Claims Adjudication Payment Dispute Form.
To receive payment for services rendered to Maryland Medicaid recipients, MDH requires all providers to maintain an active enrollment status in ePREP.
ePREP serves as a comprehensive platform for provider enrollment, reenrollment, revalidation, information updates and demographic changes. Maintaining active enrollment minimizes the likelihood of claim denials.
To enroll in ePREP or check the status of prior enrollment, go to the Maryland Dept of Health Provider Enrollment page.
Access the ePREP Quick Reference Guide for more information.