Provider Portal User’s Guide

Log in to the Provider Portal at provider.carefirst.com.

Once logged in, you will see the CareFirst Direct home page and the ‘Member Search’ screen.

The tabs across the top will appear based on the access you have within CareFirst Direct.

To begin the process of checking the status of a claim ensure the ‘Eligibility/Benefits & Claims Status’ tab is selected and then enter the following information in the field provided:

• - Member ID
• - Date of Birth
• - Date of Service (this will automatically default to today’s date)

and click ‘Next’.

The results of your search will then display.

Select the correct Member by clicking on the  next to his/her name.

Under ‘I would like to see’, select ‘Claim Status’.

Note: You can set Claim Status as your default selection for future searches by clicking on

Once you select Claim Status, a drop down will appear allowing you to enter a Date Range. You have the following options:

• - Last 30, 60 or 90 days
• - Year to Date
• - Custom Range

Make your selection and click ‘Next’

Based on your search criteria, general claim status results will display, including:

• - Provider Name and ID
• - Date of Service
• - Total Claim
• - Claim Number
• - Claim Status
• - Patient Account #

To view a specific claim, click on the corresponding ‘Claim Number’ hyperlink.

Clicking on the ‘Claim Number’ hyperlink will open more detailed information, which includes:

• - Claim Information (Claim Number, if it was adjusted, Status, Date of Service, Adjudication Date, Check/EFT Date and Number)
• - Provider Information
• - Summary of Payment Information (Total Charges, Total Non-Allowed and Allowed amount, Total Paid amount, Deductible, Copay, Coinsurance, etc.)

From here, you can click on the line number hyperlink to view the details of that line.

You can also navigate to any additional lines of information for the claim by clicking on the  .

‘I would like to’ Navigation

You will notice throughout the Claim Status search screens you are provided helpful navigation options under the ‘I would like to’ heading. From there, you are able to do the following:

• - View Eligibility for the Member you have searched for
• - Go directly to the Prior Authorization/ Notifications page
• - Submit a Claim Inquiry
• - Complete a search for a New Member