Credentialing FAQs

Answer: No, once you've submitted your information through CAQH ProView^® and completed the CareFirst Questionnaire, you have satisfied the credentialing requirements.

Answer: CAQH ProView^® is where you go to complete and submit new credentialing applications and regularly update your application information ensuring it is accurate. CareFirst utilizes CAQH ProView for its credentialing and recredentialing processes; however, CareFirst does not utilize CAQH Proview for maintaining our Provider Directory information.

Answer: CareFirst does not utilize CAQH ProView for maintaining our Provider Directory information. In order to ensure your information is accurate in our directory, you should access the self-service tool on the CareFirst Provider Portal. Federal law requires all providers to attest and/or update their directory information at least every 90 days with CareFirst directly. For more information on how to access and utilize CareFirst’s self-service tool, review the Update Your Practice Info page.

Answer:

• Application: Once you are registered with CAQH ProView, please continue to review, and make regular updates any time your provider information changes (or at least once each quarter). You will be sent a reminder from CAQH to review, update, and attest your data.
• Provider Directory Data: CareFirst’s self-service tool is not integrated with CAQH ProView. All providers must attest and/or update their directory information with CareFirst directly at least every 90 days. For more information on how to access and utilize CareFirst’s self-service tool, review the Update Practice Info 

Answer: Call CareFirst Provider Information and Credentialing at 410-872-3500 or 877-269-9593.

Answer: Please send an email to carefirstmedicareadvantage@carefirst.com for information about joining the Medicare Advantage HMO or PPO networks. CareFirst Advantage, Inc. offers eligible providers an opportunity to participate in the CareFirst Medicare Advantage HMO network, which is utilized for the CareFirst Advantage product, an Individual HMO product. CareFirst Advantage PPO, Inc. offers eligible providers an opportunity to participate in the CareFirst Medicare Advantage PPO network, which is utilized for the CareFirst BlueCross BlueShield Group Advantage product, a Group PPO product.

Answer: Effective May 9, 2019, lactation consultant providers are able to complete the credentialing process using CAQH ProView®.

If you are not yet registered for CAQH ProView, learn more and register at http://proview.caqh.org/, or learn more from their Directory Reference Guide or Frequently Asked Questions.

Answer: Lactation Consultations may be provided by certain licensed medical professionals who possesses specific training in Lactation Consultation. Other medical professionals may provide Lactation Consultations if they have one of the following certifications:

• CLC - Certified lactation counselors (CLC) are professional breastfeeding specialists trained and certified to counsel mothers about breastfeeding and to help with a variety of breastfeeding issues.
• IBCLC - An International Board Certified Lactation Consultant (IBCLC) specializes in comprehensive breastfeeding support and counseling, and the clinical management of breastfeeding. An IBCLC has completed extensive formal lactation education, clinical training, has passed an international certification exam, and has continuing education requirements in lactation. They may also be called a Registered Lactation Consultant.

Answer: If you are interested in joining our network, please complete the Provider Application (PDF) form to initiate the application process. Once completed, please mail the application to P.O. Box 14763, Lexington, KY 40512. Athletic Trainers should not utilize CAQH ProView. Keep in mind only Athletic Trainers affiliated with a participating group in Virginia are eligible to apply.

Answer: If you are unable to submit your application electronically, please fill out the Provider Application (PDF) form and send it via mail to the following address: Mail Administrator, P.O. Box 14763, Lexington, KY 40512.