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.

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.