Claims

Claims for CareFirst 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 by calling 800-282-4548 or visiting the website at Availity Essentials Provider Portal

Paper Claims

Paper using a CMS 1500 or UB04

Mail paper claims to:

CareFirst 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 Community Health Plan Maryland’s claims submission guidelines, please call our Provider Relations Department at 800-730- 8543.

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.

Claims Adjustments

All requests for claims adjustments or reconsiderations must be submitted within 180 days of the date of remittance and mailed to the address below. Please include a written description of the issue and a reference to the initial claim.

CareFirst Community Health Plan Maryland
ATTN: CLAIMS ADJUSTMENTS
PO Box 915
Owings Mills, MD 21117

Emergency Room Auto-Pay Information

Effective January 2017

CareFirst Community Health Plan Maryland (CareFirst CHPMD) will implement emergency room auto pay criteria to determine payment to hospitals. CareFirst CHPMD reserves the right to audit claims in accordance with Maryland regulations for consistency between clinical documentation and information presented on the bill (including the reported diagnosis).

If you have questions about the auto-pay list, please email our Provider Relations Department at ProviderMD@CareFirst.com