- If you cannot complete your eligibility/benefits inquiry online, please contact us at 800-842-5975.
- Medical Professional Providers: Provider Directory Updates Self-Service tool will be unavailable beginning 2/17. Click Here for details.
Forms
Administrative
Change in Provider Information - Institutional/Ancillary Please submit letterhead with this form. |
Change in Provider Information – Professional Please submit letterhead with this form. |
D.C. Minor Vaccination Consent Notification Form. |
Hospital Attestation for Patient Safety Initiatives |
Institutional Provider Claims Important information on the CMS Website. |
Professional Provider Claims |
Provider Inquiry Resolution Form Do not use this form for Appeals or Corrected Claims. This form is to be used for Inquiries only. |
Provider Refund Submission Form |
Uniform Consultation Referral Form The editable version of this form is available by logging into the Provider Portal. |
Authorization/Extension Requests
Behavioral Health
Dental Credentialing
Institutional/Ancillary Credentialing
Medicare Advantage Forms
PCMH Member
PCMH Enrollment
Pharmacy Prior Authorization
Prior authorization requests for drugs should be requested electronically through the CareFirst Provider Portal.
Drug Policies and additional information is available on the Pharmacy Prior Authorization page.
Pharmacy Forms
Independent Review Entity Forms