Information for Providers

It’s important to connect with your patients regarding any pre-certification and preauthorization information, which vary by plan. The patient may be subject to additional charges if he/she doesn’t receive this documentation, when required. Log in to access more detailed information.

The online Medical Policy Reference Manual contains approved medical policies and operating procedures for all products offered by CareFirst.

Medical policies, which are based on the most current research available at the time of policy development, state whether a medical technology, procedure, drug or device is:

• experimental/investigational
• cosmetic
• medically necessary

Operating procedures provide specific benefit information and/or instructions.

PLEASE READ: The medical policies in this reference manual do not apply to those CareFirst Administrators group health plans where independent utilization review vendors determine the medical necessity of services that require pre-certification/pre-notification. To verify coverage or benefits or determine pre-certification/pre-notification requirements for a particular member, call 866-945-9839 or send an electronic inquiry through your established connection with your local Blue Plan.

Members of some group health plans may have terms of coverage or benefits that differ from the information presented here. The following information describes the general policies of CareFirst Administrators and is provided for reference only. This information is NOT a guarantee of payment. To verify coverage or benefits or determine pre-certification or pre-notification requirements for a particular member, call 866-945-9839 or send an electronic inquiry through your established connection with your local Blue Plan.

Services requiring pre-certification include inpatient admissions (hospital, extended care facility, skilled nursing and rehabilitation facility stays).

Services that may require pre-notification include: