Claims FAQs

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General Electronic Claims FAQs

How does the electronic submission process work?

Answer:

  • Providers send electronic claims to CareFirst through one of our preferred vendors/clearinghouses.
  • The vendor/clearinghouse will edit all claims and send you a report to notify you of any errors they identify. Errors must be corrected and the claims must be resubmitted electronically.
  • Claims without errors are forwarded to CareFirst for processing and additional editing.
  • You will receive an additional report from the clearinghouse to confirm receipt of claims by CareFirst and advise you of any additional errors. Again, you have the opportunity to correct all errors and resubmit claims electronically.

How does my office begin submitting claims electronically to CareFirst?

Answer:

  • If you do not currently have a vendor or clearinghouse, you may contact one of our preferred vendors.
  • If you currently work with another vendor or clearinghouse, you must contact that vendor to inquire about the enrollment process.

Is there a telephone number that I can call regarding problems with my electronic claim submissions?

Answer: Please direct questions to your vendor or clearinghouse first. If you need further assistance, contact the CareFirst Help Desk at 1-877-526-8390 or send an e-mail to edidirectsubmission@carefirst.com.

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Electronic Fund Transfer (EFT) FAQs

How do I register for electronic fund transfer (EFT)?

Answer: To register, you must use one of CareFirst’s preferred clearinghouses. Click the link or call one of the clearinghouses below:

  • Emdeon at (866) 369-8805
  • RealMed at (877) 927-8000, ext. 1201
  • Allscripts (enrollment performed by Payspan) at (877) 623-5706, ext. 1 or ext. 2
  • RelayHealth (enrollment performed by Payspan) at (877) 527-8133, option 2

Are there any special requirements in order to receive EFT)?

Answer: Yes, you must:

  • Submit your claims electronically
  • Receive an Electronic Remittance Advise (ERA-835)*

* Some clearinghouses may have specific requirements. Contact them for details.

How long will it take for my EFT enrollment to begin

Answer: Contact your clearinghouse for specific timing. Once CareFirst receives notification that you have been enrolled, your EFT will begin with the first voucher issued after the change occurs.

What claims are included on the EFT?

Answer: Once enrolled, all claims processed by CareFirst will be included on the EFT.

Will I continue to receive my paper voucher after my EFT deposits begin?

Answer: No, your paper vouchers will be discontinued.

When should I contact my clearinghouse?

Answer: Contact your clearinghouse if you:

  • Need a copy of your ERA-835
  • Received your EFT but not your ERA-835
  • Need to make changes to your banking or contact information

When should I contact CareFirst?

Answer: If your EFT deposit was not received or it is late, contact Provider Services. For the appropriate contract information, please refer to www.carefirst.com/electronicclaims.

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