CareFirst Upgrades Prior Authorization Notification System Effective Jan. 1 for Medicare Advantage Members

Posted on 2020-12-08
Updated on 2020-12-08 09:00:00

Effective Jan. 1, 2021, CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (CareFirst) is upgrading its Prior Authorization (PA) notification system through the Provider Portal. The newly enhanced system offers easy to read dashboards, a user-friendly interface and electronic communication with CareFirst clinical staff.

This upgrade is being released throughout 2021 starting first with Medicare Advantage (MA) members in January and will be available for all members in mid-2021.

What Does This Mean for You?

CareFirst Direct will look different. After logging into the Provider Portal, you will see a new PA Notification Home Screen after selecting the Prior Auth/Notifications tab.

For inpatient, Outpatient and Genetic Testing Authorizations for MA Members, you will click on “Start Now” within the “Medical (Medicare Advantage)” section. Then, you will be taken to the new PA notification system to complete your request.

To assist you with entering PAs for Medicare Advantage members, CareFirst is offering webinars. These webinars will include an overview of the requirements, a detailed step by step review of the process as well as other important facts. Register today by clicking the date and time of the session you would like to attend. You only need to attend one class since they are the same.

Professional Provider Training

Institutional/Ancillary Provider Training

In addition, on-demand training will be available later this month by accessing > Learning Library.

If you have questions about this change, contact your Provider Relations Representative.