Credentialing FAQs

Expand All | Collapse All

I already submitted a CAQH application, do I need to complete a Maryland Uniform Credentialing Form?

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

Where do I go if I need to update my information?

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.

In order to ensure that your information is accurate in our directory, you must use the self-service tool on the CareFirst Provider Portal.

When do I use CareFirst’s Self-Service Tool? When do I use CAQH Proview?
  • Attest to your CareFirst Provider Directory information every 90 days.
  • Make updates to your CareFirst Provider Directory data as soon as it changes.
  • Complete and submit new credentialing applications (must complete the CareFirst CAQH Questionnaire). 
  • Regularly update your credentialing application information ensuring accuracy.
How often do I need to update my information?

Answer:

  • Credentialing 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 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 
Who do I call if I have additional questions regarding credentialing and participation?

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

How do I learn more about joining CareFirst’s Medicare Advantage HMO and PPO networks?

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.

When can health care providers, who offer lactation consultation services, start the credentialing process?

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.

Who may provide lactation consultations?

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.

Expand All | Collapse All