Professional Credentialing Overview

Why CareFirst?

Become a 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.

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.


Why CAQH?

The Council for Affordable Quality Healthcare (CAQH) ProView® application is compliant with the Maryland and District of Columbia Uniform Credentialing form regulations.

Three Reasons to use CAQH ProView

  1. 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
  2. Update your information – If your information changes, you can quickly update it online.
    • Attestation can be completed within minutes and should be done every 120 days.
    • Updated information is available to any organizations you have authorized.
    • Important Note: Updating your data with CAQH does not satisfy the Consolidated Appropriations Act (CAA) mandate with CareFirst. For more information, refer to the Update Your Practice Info page.
  3. Meet recredentialing requirements – CareFirst requires providers to complete a recredentialing process every three years.

To learn more about CAQH, check out their FAQs.


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