- If you cannot complete your eligibility/benefits inquiry online, please contact us at 800-842-5975.
- CareFirst Direct Eligibility/Benefits and Claims Status will be unavailable Fri,Oct 11 at 9:30PM to 11:30PM for all members.
- Due to a planned system upgrade beginning Friday, October 11 at 8:00 PM, and continuing through Monday, October 14 at 8:00 AM, you may experience a delay in your information appearing on CareFirst portals. We expect that changes to member data will be reflected on the portals by Wednesday, October 16. Your patience is appreciated.
Machine Readable Data
Machine Readable Data for Provider Network and Prescription Formulary Content for Federally-Facilitated Marketplace (FFM) Qualified Health Plans (QHP)
As required by the Patient Protection and Affordable Care Act, for plan years beginning on or after January 1, 2016, qualified health plan (QHP) issuers in the Federally-Facilitated Marketplace (FFM) are required to publish information regarding their provider directories and formulary drug lists on their website in a machine-readable format.
This requirement increases and enhances consumer transparency by allowing software developers to access up-to-date, accurate and complete formulary and provider data needed to create innovative and informative tools.
In accordance with this requirement, the following files are available for use:
- Index data
- Plan data
- Medical provider data - file 1
- Medical provider data - file 2
- Medical provider data - file 3
- Medical provider data - file 4
- Medical provider data - file 5
- Medical provider data - file 6
- Medical provider data - file 7
- Medical provider data - file 8
- Dental provider data - file 1
- Dental provider data - file 2
- Dental provider data - file 3
- Dental provider data - file 4
- Dental provider data - file 5
- Prescription formulary data - file 1
- Prescription formulary data - file 2