Update on CareFirst’s Prior Authorization Notification System
On January 10, CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (CareFirst) updated its Prior Authorization (PA) Notification system through the provider portal. The newly enhanced system offers easy to read dashboards, a user-friendly interface, real-time approvals for authorizations meeting certain criteria, and electronic communication with CareFirst clinical staff. We’ve had over 1,000 providers participate in our live webinars about this system change so far.
Note: This upgrade was released in 2021 for Medicare Advantage (MA) members and is now available for Commercial and FEP members. Group MA prior authorizations should also be entered via Altruista. This update does not apply to drug prior authorizations submitted through the Novologix system. Users can access Novologix from the ‘Pharmacy Authorizations’ section on the Prior Auth/Notifications landing page at provider.carefirst.com. See the FAQs linked below for more information.
Update
After the initial launch, some providers have reached out with questions. We wanted you to know we’ve heard your feedback and continue to develop additional resources as you navigate the new system.
What Training and Resources are Available?
Many of the calls we are receiving are due to new functionality of the system. Please review the resources below, including the FAQs, for tips and tricks.
- Our on-demand training and interactive user guides are available 24/7 at www.carefirst.com/providereducation. Visit our Courses by Topic page and select the Authorizations section for guidance on entering prior authorizations and notifications.
- Live Webinars are also available, click here to register.
- Refer to these FAQs for helpful tips and tricks.
- Call your technical support number for any technical needs for issues not mentioned below so we can log appropriately. Please note that our Provider Service teams will be unavailable beginning noon today, Friday, January 14, but will reopen on Tuesday, January 18. Technical support will remain open through the holiday weekend.
In the meantime, note that if an authorization remains in pended status longer than expected, it will be manually adjusted by the end of the day on Tuesday, January 18, and it is not necessary to cancel scheduled patient procedures. You can expect authorizations for medically necessary procedures covered under the member’s benefits that are not cosmetic, experimental, and investigational in nature to be approved. As a reminder, there is a 7-day window to enter retrospective inpatient notifications and a 3-day window for outpatient authorizations. You can go through Pre-Certification to get the authorization entered for currently-admitted members or Service to process notification for those who are no longer admitted.
All providers should be able to enter authorizations by following the instructions provided in the existing training materials. If you are unable to enter authorizations, please contact technical support. We are continuing to listen to your feedback and will respond accordingly to your concerns.
CareFirst’s highest priority is patient care and working with you to maintain continuity of operations. Last week we announced flexibility to several of our utilization management policies and timelines.
We appreciate your patience as you become acquainted with this new system, and we’ll continue to keep you updated.