- PriorAuth /Guiding Care/ Population Health applications will be unavailable Fri, Aug 07 from 7PM to Sat, Aug 08 at 4AM
- PriorAuth/Provider Portal/CFD applications will be unavailable Sun, Aug 09 from 6AM to 10AM
- EFT Payments Issued as Checks:CareFirst identified on or around May 10 an issue in which some providers who were set up to receive ACH/EFT payments instead received paper checks. This issue remains under active investigation. Providers do not need to take any action at this time. We are working toward resolution and will continue to share updates as more information becomes available, including expected timing.
- ERAs Reflecting Check Information Instead of ACH:CareFirst is aware of an issue in which some Electronic Remittance Advices (ERAs) reflected check payment information instead of ACH/EFT details. This issue was resolved on May 29, 2026. CareFirst is currently working to reissue impacted ERAs to include the correct ACH/EFT information. Providers do not need to take any action at this time.
PCMH Overview
Overview
PCMH is entirely voluntary and providers who participate can earn meaningful reimbursement increases of three types:
- 12 percentage point increase added to current fee schedule
- Additional fee schedule increases (max OIA increase is 120) based on providers' engagement with their patients, the quality of care delivered to their entire cohort of patients, and actual aggregate costs of care compared to expected costs.
The PCMH program has a significant "upside" for the provider, for the patient and for CareFirst as a steward of its members' health care dollars.
Who is Eligible?
Providers who are credentialed and in good standing in all CareFirst and CareFirst BlueChoice networks and practice in the following Primary Care specialties are eligible for PCMH:
- Family Practice
- General Practice
- Geriatrics
- Internal Medicine
- Nurse Practitioners*
- Osteopathy
- Pediatrics
* Nurse practitioners (NP) must be certified by their relevant approved National Certification Board and meet all licensing/certification guidelines of the state in which the NP practices. NPs must also file an attestation that they have a written collaborative agreement with a physician of the same specialty who is in good standing in the same CareFirst provider networks.
Want More Information?
We urge you to read the full PCMH Program Description and Guidelines document for more information. (Viewing and printing this document requires Adobe Acrobat Reader, which can be downloaded free from the Adobe site. To navigate the contents of the Program Description and Guidelines, read our "tips".)
Take advantage of the PCMH-specific training opportunities available through the Learning and Engagement Center.