If you cannot complete your eligibility/benefits inquiry online, please contact us at 800-842-5975.
Change Healthcare Notice
Need Insurance?
Already a Member
For Employers
For Brokers
For Providers
Community
Skip Navigation
Log in
Home
Join Our Networks
Professional
Overview
How to Apply
FAQs
Institutional/Ancillary
Credentialing Overview
How to Apply
Credentialing Forms
Credentialing FAQs
Dental
Credentialing Overview
How to Apply
CAQH Universal Credentialing
Credentialing Forms
Credentialing FAQs
Find a Provider Rep
Programs/Services
Medical
Electronic Capabilities
Medical Policy
Pre-Cert/Pre-Auth (In-Network)
Pre-Cert/Pre-Auth (Out-of-Area)
Medical Forms
Medical News
Payment Policy
Dental
Dental Overview
Dental Electronic Capabilities
Dental NPI & Payer Codes
Dental Clinical Criteria
Dental Resource Guide
Dental Forms
Dental News
Dental Seminar
Dental Wellness
Pharmacy
Pharmacy Exception Requests
Pharmacy Resources
Pharmacy Prior Authorization
Care Management
PCMH
PCMH News
Quality & Affordability
Clinical Resources
Care Management Form
Profile Score
Virtual Connect Program
Wellness/Incentives
Blue Rewards
Resources
Administrative
CareFirst Direct
Update Practice Info
Manuals & Guides
Forms
Inquiries & Appeals
Medicare Appeals and Grievances
Claims
Claims Submission
Dental Claims Submission
NPI
Dental NPI & Payer Codes
Ancillary Claims
Corrected Claims
Medicare Secondary
Paper Claims
Resources
Looking for Support?
Federal Employee Program
CareFirst Direct User Guides
Coronavirus Resource Center
News/Training
Learning and Engagement Center
Newsletters
News Archives
Manuals and Guides
A
A
A
Care Management
PCMH
Overview
Enrollment Materials
Forms
PCMH Program FAQs
Evaluation
PCMH News
Quality & Affordability
After Hours Care
National Laboratories
Radiology Centers
Ambulatory Surgery Centers
Medication Choices
Profile Score
Clinical Resources
Clinical Practice Guidelines
Preventive Service Guidelines
Disease Management
High-Risk Pregnancy Program
Opioid Support
CERL Report
Language Line
Care Management Form
Profile Score
Virtual Connect Program
providers
Care Management Form
Your information was submitted successfully.
Could your patient benefit from working with a care manager? If yes, fill out this short form, and we will respond to your request within two business days.
* Required
*
Member's Date of Birth
*
Member ID (as listed on your patient's CareFirst Insurance Card)
How would you like to be notified of referral status?
Phone
Email
*
Brief Clinical Summary (Reason for Referral)
Member's Primary Language:
English
Spanish
Korean
Other
Please verify that you are not a robot.
Submit
