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    What are the downgrade policies in CareFirst plans?

    Answer:

    • Composite restorations are not downgraded to amalgam restorations.
    • Porcelain crowns are not downgraded to gold crowns.
    • Composite restorations are limited to once every twelve (12) months.


    Do CareFirst plans have a missing tooth clause?

    Answer: No, CareFirst Dental plans do not contain a missing tooth clause.

    What is the deductible carryover?

    Answer: CareFirst Dental plans have a three-month deductible carryover. If a member’s deductible was applied in the last three months of their previous benefit period, the applied deductible carries over to the next benefit period’s deductible waiver.

    Please note: This does not apply to Affordable Care Act (ACA) compliant medical plans.

    What is the difference in the seat date and the prep date?

    Answer: In cases where multiple visits are necessary, CareFirst provides the benefits available under the member’s contract only upon completion of treatment. Therefore, dental procedures that require multiple visits, such as crowns, root canal therapy, etc., should be billed only at the completion of service. For crown restorations, the completion date is cementation or seat date.

    What is CareFirst’s Payor ID?

    Answer: Send claims electronically through your clearinghouse by using the payor ID 00580.

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