Professional Credentialing Overview
As a not-for-profit organization, we are pleased to be able to offer the opportunity to become part of the largest provider network in the region. Today, more than 90% of the region's most dedicated health care providers serve 3.3 million members in Maryland, Washington, D.C., and Northern Virginia.
Which networks can I participate in?
Professional providers are eligible to participate in our:
- BlueChoice, and/or
- Regional Participating Preferred Network (RPN)
To avoid confusion and unexpected out-of-pocket expenses for members, all providers in the same practice must participate in the same provider networks.
Providers have the right, upon request, to review the information used in credentialing decisions to correct inaccurate information and to obtain the status of the credentialing process. To request this information, call 877-269-9593 or 410-872-3500.
CareFirst Community Health Plan Maryland (CareFirst CHPMD), a Medicaid Managed Care Organization, information can be found at https://www.carefirstchpmd.com/for-providers/provider-contracting.
CareFirst DualPrime, a Medicare Advantage Prescription Drug Plan for those with both Medicare and Medicaid, information can be found at https://www.carefirstmddsnp.com/About-Us/Contact-Us.
CareFirst utilizes the Council for Affordable Quality Healthcare (CAQH) ProView® solution as our Credentialing Verification Organization.
Three Reasons to use CAQH ProView
- Meet reporting requirements – When you use CAQH’s ProView solution, you can easily self-report data required by health plans, hospitals and other organizations.
- Only enter your information once to credential with multiple insurers
- Eliminate or reduce duplicative paperwork
- Update your application information – If your application information changes, you can quickly update it online.
- Attestation with CAQH can be completed within minutes and should be done every 120 days.
- Important Note about Provider Directory Data: You MUST update your provider directory information with CareFirst directly. To assist, CareFirst has a self-service tool integrated within our Provider Portal you can utilize to update your data. For more information, refer to the Update Your Practice Info page.
- Meet recredentialing requirements – CareFirst requires providers to complete a recredentialing process every three years.
To learn more about CAQH, check out their FAQs.