BlueLink

Vol. 3, Issue 3 June 2001


A NEWS PUBLICATION FOR PARTICIPATING PHYSICIANS, PROVIDERS AND INSTITUTIONS

Collective News
FreeState Exits Several Markets
SEGO Product Changes
Formulary Update
Drugs Requiring Prior Authorization
New Technology Assessed
Patient Rights and Responsibilities
Protecting Member Confidentiality
Be Sure to Use Alphabetic Prefixes

Indemnity News
MPOS Referral Process Simplified
Avoid Auto Zone Claim Error
One Form for Provider Application & Credentialing
New PT/OT/ST Authorization Forms
Dental Precertifications Eliminated
BlueCard Managed Care POS Reminders
Upcoming Practitioner & Staff Training
Open Enrollment Benefits Enhanced

Important Phone Numbers
 



FreeState Health Plan Withdraws from Small Group and Individual Markets to Make Way for New Regional HMO

CareFirst BlueCross BlueShield (CareFirst) has been working to streamline several of its subsidiary HMO products into a regional managed care company serving Maryland and the National Capital area.

CareFirst's National Capital area subsidiary HMO, CapitalCare, Inc., will soon be expanded into the Maryland region. The expanded CapitalCare product will offer access to physicians throughout CareFirst's entire region at competitive pricing. It is CareFirst's intention to name the expanded CapitalCare product CareFirst BlueChoice, Inc.

As part of this transition, CareFirst's Maryland region subsidiary HMO, FreeState Health Plan, Inc., will soon withdraw from the Individual and Small Employer Group Options (SEGO, also known as Maryland Small Group Reform or MSGR) markets in Maryland. This action does not affect large group (51+) business.

Maryland Individual and SEGO market members were notified of this transition by mail on or around June 12, 2001. Over 180 days' notice of coverage termination (the minimum timeframe required by the State of Maryland) has been given to allow members time to select a new health insurance plan. All affected members will qualify for health coverage from a CareFirst company regardless of health status.

  • Individual market members are covered by FreeState Health Plan until December 31, 2001. Later this year, these members will receive information from us regarding other CareFirst products, including the expanded CapitalCare product. They'll be instructed to select a new health insurance plan prior to December 31, 2001.

  • This change will affect SEGO members upon their respective contract renewal date beginning January 1, 2002. As these members' contracts renew, they will be able to choose from other health insurance plans available from CareFirst including the expanded CapitalCare product.

We will continue to provide you with updates during this consolidation and appreciate your patience and assistance. If you have any questions about the Individual and SEGO market exits, please contact Provider Networks Management at 410-528-7103 or 800-228-8161.

BENEFITS UPDATES

Maryland Small Employer Group (SEGO) Product Changes

 

The Maryland Small Employer Group Options (SEGO) product will soon undergo benefit updates brought about by State of Maryland regulatory changes and by CareFirst. These changes will affect new and renewing CareFirst indemnity and FreeState Health Plan SEGO accounts beginning July 1, 2001. (Please see the preceding article for important information on FreeState Health Plan SEGO accounts.) Under the new changes, coverage will be provided for:

blue box  Colorectal screening for men and women 50 years or older, consisting of:

  • A yearly fecal occult blood test, accompanied by digital rectal examination, plus flexible sigmoidoscopy every 5 years
  • A colonoscopy, accompanied by digital rectal examination, every 10 years; or
  • A double contrast barium enema, accompanied by digital rectal examination, every 5 years

blue box  Medical food for persons with metabolic disorders when ordered by a health care practitioner qualified to provide diagnosis and treatment in the field of metabolic disorders

blue box  An annual chlamydia screening test for women who are younger than 20 years old who are sexually active

blue box  Direct access to obstetric and gynecological care as specified in the Annotated Code of Maryland (Article 5-816)

CareFirst has also made changes to the coinsurance, deductibles, copayments, and out-of-pocket maximum amounts. Be sure to contact BLUELINE or the FreeState ACCESS system to verify these and other benefits for CareFirst or FreeState Health Plan SEGO members you may see.

PHARMACY UPDATE

Pharmacy and Therapeutics Update

The P&T Committee announces the addition of the following drugs to the CareFirst formulary.

Brand (Generic) Drug Indication
Celebrex (celecoxib) COX-2 inhibitor (NSAID)
Concerta (methylphenidate) ADHD
Starlix (nateglinide) Oral hypoglycemic
Visicol (various sodium
phosphate salts)
Bowel cleansing product

The following drugs have been removed from the formulary:

Brand (Generic) Drug Indication
Nolamine
(phenylpropanolamine containing)
Decongestant/antihistamine
combination product
Poly-Histine-CS
(phenylpropanolamine containing)
Antitusive combination product
Poly-Histine-D
(phenylpropanolamine containing)
Decongestant/antihistamine
combination product
Poly-Histine-DM
(phenylpropanolamine containing)
Antitusive combination product

Drugs Requiring Prior Authorization

The P&T Committee has established prior authorization criteria for the following drugs with input from participating physicians and consideration of current medical literature. In order for a member to receive coverage for a medication requiring prior authorization, the physician must call 800-294-5979 to provide patient-specific information. This list is subject to change. Exclusions and limitations may vary depending upon the member's benefit design.


Important Correction Concerning Nor QD

In the February 2001 issue of BlueLink, we inadvertently included Nor QD in a list of drugs removed from the market. Nor QD has not been withdrawn from the market by the FDA nor by the manufacturer. However, Nor QD has been removed from CareFirst's formulary. The preferred formulary alternative for Nor QD is Micronor.

NEW TECHNOLOGY

New Technology Evaluated

CareFirst's Technology Assessment Unit evaluates new and existing technologies for application to our indemnity and managed care benefit plans. The unit relies on current medical literature, local expert consultants, and physicians to determine our position on new technologies and whether those technologies meet our criteria for coverage. The Technology Assessment Unit recently made the following determinations:

New Technology Description CareFirst Determination
Lysis of epidural adhesions for treatment of pain related to failed back surgery Injection of hypertonic saline into epidural space via epiduroscopy or guided percutaneous approach (Racz catheter) Considered investigational based on lack of published data.
Billing code 62263
Disc replacement surgery (SB III charite prosthetic intervertebral disc) Artificial disc to replace a degenerated disc as an alternative to fusion surgery Considered investigational. This device is not FDA approved.
Billing code 22899
Continuous glucose monitoring for diabetes mellitus Use of a monitoring device worn on the body which continuously measures glucose levels in interstitial fluid for up to 72 hours Considered medically necessary for diabetic patients meeting certain criteria. Medical policy is in development.
Billing code 99199
Laser assisted myringotomy (i.e., OtoLAM) Use of CO2 laser to perform myringotomy in patients with otitis media Considered medically necessary for treatment of patients with pediatric or adult otitis media who require myringotomy for relief of pressure and pain from the tympanic membrane.
Billing code 69420. 69433 is used when a ventilating tube is inserted in the same session.

Correction: In the February 2001 issue of BlueLink, the billing code for kyphoplasty was listed as 27999. The correct billing code for kyphoplasty is 22899.

GENERAL POLICIES AND PROCEDURES

Know Your Patients' Rights and Responsibilities

CareFirst and FreeState Health Plan are committed to maintaining mutually respectful relationships with our members while delivering high-quality, cost-effective health care. Our respective CareFirst and FreeState Member Rights and Responsibilities statements acknowledge our responsibility, and that of our practitioners, to provide services and information that promote members' rights. They also outline expectations regarding our members' responsibilities as active participants in their benefit plan.

The following is CareFirst's Member Rights and Responsibilities Statement for its traditional (indemnity) and Preferred Provider Network members. FreeState's Member Rights and Responsibilities are available in your new Practice Administrative Resource Guide.

CareFirst's Member Rights and Responsibilities Statement

Rights
Each member has the right to:
blue box  Select a physician and receive coordinated care under the management of that physician.
blue box  Expect Health Plan representatives to treat you with respect and recognition of your dignity and need for privacy.
blue box  Participate with practitioners in decision making regarding your health care.
blue box  Expect appropriate confidentiality of medical information and records except where release is authorized or required by law.
blue box  Receive information about the health plan, its services, its practitioners and providers, and members' rights and responsibilities.
blue box  Receive information describing services provided under your benefits and any change in your benefit coverage.
blue box  Have access to health plan Member Services Representatives who can answer questions and assist in resolving problems.
blue box   Bring grievances, problems or complaints to the attention of CareFirst BlueCross BlueShield, and have these resolved through a timely and organized resystem.
blue box   Have a candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage.

Responsibilities
Each member has a responsibility to:
blue box  Select a physician with whom you can establish a good patient-physician relationship.
blue box  Consult with your physician prior to seeking care from a specialist and follow established precertification and authorization procedures.
blue box  Cooperate with all health professionals involved in your care and treatment.
blue box  Pay member copayment or coinsurance at the time of service.
blue box  Be on time for appointments and notify providers promptly when an appointment must be canceled.
blue box  Provide information that the health plan and its practitioners and providers need in order to care for you.
blue box  Read all membership materials carefully and follow the benefits, policies and procedures.
blue box  Express opinions, concerns or complaints about services given to you, using established processes.
blue box  Pursue a healthy lifestyle.

Keeping Member Information Secure and Confidential

CareFirst strongly supports our members' right to privacy and the confidentiality of medical information. Here's how CareFirst uses and safeguards member information.

CareFirst's general policy is that all records containing confidential medical and insurance information must be handled and discarded in a way that ensures the privacy and security of the records. By enrolling with a CareFirst health plan, subscribers provide routine consent for the release of information to be used in the delivery of health care, payment of doctors and other providers, measurement and improvement of care and service, preventive health and disease management programs, investigation of complaints and appeals, and member surveys.

CareFirst will seek special consent from members before releasing information that is requested in conjunction with a worker's compensation or auto insurance claim or by an attorney. Special consent is sought before releasing information that could result in the member being contacted by another company for marketing purposes and prior to the release of information from behavioral health practitioners to the member's primary care physician or specialist. CareFirst's members may access their own medical records by contacting their doctor's office; however, the member must follow the doctor's procedures for accessing medical information. Members enrolled in contracts issued under CareFirst's Virginia Certificate of Authority may access any of their medical records in the Plan's possession directly from CareFirst.

CareFirst policy regarding the disclosure of information to employers limits such information to that needed to administer the health plan without disclosing patient-identifiable information. The employer must agree to protect information from being used for any decisions affecting the employee. The employer must also identify persons or positions that may have access to the information and ensure that there are measures in place to prevent unauthorized access. With regard to our quality improvement efforts, CareFirst ensures that medical record reviews are conducted in non-public areas and that final reports do not include member-identifiable information.

Recent developments in the area of privacy include the Gramm-Leach-Bliley Act. This mandate requires us to inform members about our privacy practices. By July 1, 2001, we will send our members a notification explaining the information we may collect about them, how we use it, and under what circumstances we will disclose it. If you would like a copy of the notification, please call 800-321-3497.

CareFirst practitioners are expected to implement confidentiality policies and procedures within your practice that address the disclosure of, access to, and storage of member-specific medical information. CareFirst reviews practitioner confidentiality policies and practices during pre-contractual site visits for primary care physicians. Our complete policy is available by calling Provider Networks Management at 410-528-7103 or 800-228-8161.

BILLING AND CLAIMS

Remember Alphabetic Prefix on All Claims

It is imperative that all claims include the alphabetic prefix of the member's ID number. Sometimes, a patient may present a CareFirst membership card without a prefix. In these instances, you may either call BLUELINE at 410-581-3535 or 800-248-8410 or your Provider Claim and Benefit Inquiry account team for the member's prefix.

When you call BLUELINE, the alphabetic prefix information is available by first making the announced selection for Eligibility and then selecting either Coverage or Waiting Periods. The alphabetic prefix is given within both of these categories. You will need to provide the membership number, the member's sex/relationship code, and the member's date of birth. When BLUELINE asks for the date of service, use the date of your phone call (BLUELINE will not accept a date in the future). You will also be asked for your provider number and type.

MAKING BUSINESS WITH US EASIER

MPOS Referral Process Simplified

CareFirst continues to look for ways to make doing business with us easier. Beginning with applicable services performed on or after June 1, 2001, we no longer require the submission of Maryland Point of Service (MPOS) referral forms for the services listed below. Members will receive in-network benefits as long as these services are rendered by a Preferred Provider. Some services, like medical supplies, will be paid in-network even when the service is provided by an out-of-network provider. PCPs should assist members in selecting a Preferred Provider and should not refer members to non-network providers (participating or non-participating).

Although PCPs are no longer required to submit the written referral form to CareFirst for the following select services, we continue to encourage members to seek their primary care physician's guidance in making decisions about their specialty care options. This preserves coordination of care and helps members maximize their benefits.

Services no longer requiring submission of a referral to CareFirst (subject to some limitations):

MRI, CAT scan and Holter monitor1,2
Renal dialysis treatment4
DME (requires submission of the DME certification form along with the claim)1,2
Prosthetic devices and orthopedic braces1,2
Medical supplies1,2
Chemotherapy and radiation therapy treatments (requires a PCP's long-standing referral)1,4
Ophthalmology (non-routine)5
Coordinated Home Care (CHC Agencies)3
Physical, occupational and speech therapy1,3,4
Oral surgery5

1 Must be prescribed by a physician.
2 Will be paid in-network when billed from either an in- or out-of-network provider.
3 Authorization of treatment plans is required.
4 Must be rendered by a PPN provider or at any facility.
5 In-office visits only by a PPN provider.

Please note that benefit administration provisions such as inpatient hospital precertification, the outpatient preauthorization program and medical policy still apply. Final determination of covered benefits is subject to the terms of the patient's benefit contract.

Our provider surveys and focus groups have shown that referrals are often cited as an administrative burden you'd like to see minimized. We hope this change helps simplify your role in facilitating member access to quality health care. If you have any questions, call Provider Networks Management at 410-528-7103 or 800-228-8161.

ACCOUNT UPDATE

Avoid Common Error Contributing to Auto Zone Claims Rejections

Auto Zone is a national account that became effective January 1, 2001. The alphabetic prefix assigned to this account's members is AZO (all alphabetic letters).

Some CareFirst providers are submitting claims with the prefix AZ0 (AZ followed by a numeric zero instead of an alphabetic letter O). These claims will be rejected and/or delayed. Be sure to use the all-alphabetic AZO prefix to avoid claims processing delays and rejections.

MAKING BUSINESS WITH US EASIER

New Form Simplifies Credentialing and Application

Maintaining up-to-date and accurate information on all participating practitioners is important to CareFirst. Effective December 2000, the Maryland Insurance Commissioner requires all health insurance carriers to accept the Maryland Uniform Credentialing Form. CareFirst has replaced our various applications and credentialing questionnaires with this new form.

You can reduce your practice's administrative burden by taking the time to complete this new form, save it, and update it as necessary. You'll simply sign and date it whenever any insurance carrier or managed care plan requests information from you. If your practice consists of multiple providers, you'll want to save a completed form for each of your existing individual practitioners. You may also want to save a version of this form on which just the office information is complete. When a new practitioner joins your group, you'll complete the individual sections accordingly.

Submit the completed Maryland Uniform Credentialing Form to us when:

blue box  Your participating practice would like to become part of another CareFirst network (for example, our Preferred Provider Network or our Maryland Point of Service network)

blue box  Your group practice is adding a new provider

In both of these cases, you will also need to complete an Authorization Form that we will send to you. In some cases, we'll also ask you to complete a Group/Corporate Questionnaire.

All of these forms can be obtained by calling CareFirst's Provider Information Management department at 410-880-1370 or 877-269-9593. You can also download an electronic version of the Maryland Uniform Credentialing Form from the Maryland Insurance Administraton's Web site at www.mdinsurance.state.md.us. Click on "Insurer Services" for the form.

Once we review your submitted form, we will send you the Participation Agreements for the networks for which you are approved. Upon our receipt of the signed Participation Agreements, Provider Information Management will add you to the appropriate networks. You will receive a welcome package containing your new provider numbers and effective date of participation as well as a provider manual.

Your new network participation or additional practitioner will also be made known to members via our provider directories (also made available in hardcopy).

All changes to names, addresses, tax identification numbers, etc. should also be submitted to Provider Information Management via the Maryland Uniform Credentialing Form. Complete the form with your new information and mail it to:

CareFirst BlueCross BlueShield
10455 Mill Run Circle
Mail Stop CDC/PIM
Owings Mills, MD 21117

UTILIZATION MANAGEMENT

New PT/OT/ST Authorization Forms

In January, CareFirst began using diagnosis-specific Apollo criteria to review outpatient rehabilitative physical, occupational and speech therapy visits. These guidelines were reviewed and supported by a panel of our local providers.

Two new forms have been developed for processing habilitative and rehabilitative authorizations: the Initial Authorization Request Form and the Re-authorization Request Form. These forms are aimed at more efficient processing of your requests and are being mailed to physical and occupational therapists and speech language pathologists.

Please begin using these forms as soon as possible so that your treatment plans can be approved before or concurrent with treatment.

Helpful Tips
blue box  Rehabilitative and habilitative services require authorization. Failure to seek authorization may result in a denial of claims reimbursement.
blue box  To submit a treatment plan, complete the appropriate treatment plan form (Initial or Re-authorization) and fax it to 410-605-2439.
blue box  Providers will receive confirmation, including an authorization number, via fax.
blue box  CareFirst will continue to review requests on an individual basis using Apollo criteria as a guideline. You may visit Apollo's Web site at www.apollomanagedcare.com or call 805-969-2606 to request copies of the criteria.
blue box  Inquiries related to authorizations may be directed via telephone to 410-581-3550 or 800-443-5434.
blue box  If you would like copies of the new forms, please call the Forms Request Line at 410-998-4667.
blue box  If you have any general questions, contact Provider Networks Management at 410-528-7103 or 800-228-8161.

DENTAL

Dental Precertifications Eliminated

In an effort to streamline our dental operations, CareFirst now no longer requires precertification requests for dental services. This policy took effect June 1, 2001. Dental providers seeking benefit/eligibility information prior to rendering services may obtain this information by contacting our BLUELINE Voice Response System at 410-581-3535 or 800-248-8410.

A hardcopy of the Estimate of Eligible Benefits may be obtained by submitting a claim form listing the American Dental Association (ADA) Current Dental Terminology (CDT-3/2000) procedure code(s) for the treatment to be delivered to the following address:

CareFirst BlueCross BlueShield
P.O. Box 800
Owings Mills, Maryland 21117-0800

To obtain an Estimate of Eligible Benefits for patients covered under a NASCO account, please refer to the back of the patient's membership card for the appropriate NASCO address.

Do not send supporting documentation (i.e., radiographs, models, periodontal charting, etc.) with your request for the Estimate of Eligible Benefits. This information need only accompany the claim when it is submitted for reimbursement.

Please note that these guidelines apply only to dental services covered under dental policies. Oral surgical procedures covered under medical policies, i.e., orthognathic surgery, will continue to require precertification under the medical portion of the member's contract.

Your cooperation with these guidelines will ensure that your requests are processed efficiently and timely. If you have any questions, please contact CareFirst's Provider Claim and Benefit Inquiry Dental Team at 410-581-3541 or 800-272-1580 or NASCO Provider Services at 877-228-7268.

BLUECARD NEWS

Northrop Grumman BlueCard Managed Care POS Reminders

In the December 2000 issue of BlueLink, we introduced BlueCard Managed Care Point of Service (POS). Northrop Grumman is one of several national accounts now using CareFirst's Maryland Point of Service (MPOS) network through the BlueCard Program. BlueCard Managed Care POS members reside outside of their Blue Cross Blue Shield Plan's service area. They are enrolled into CareFirst's MPOS network and are assigned an MPOS primary care physician (PCP).

You can recognize a Northrop Grumman POS member by their ID card, which carries the Northrop Grumman logo in the upper right hand portion of the card. The words BlueCross BlueShield appear in the upper left portion of the card. The words Maryland Point of Service are centered beneath. A suitcase is pictured in the lower left-hand corner. The prefix NRG precedes the member's ID number. A sample card appears below.

Northrop Grumman POS claims may be submitted electronically, and paper claims should be submitted to:

CareFirst BlueCross BlueShield
P.O. Box 1684
Cumberland, Maryland 21501-1684

 

PRACTITIONER NEWS

 

Upcoming Practitioner and Staff Seminars

CareFirst's half-day seminars for practitioners and their office staff are designed to familiarize you with our newest programs, claims submission procedures, coordination of benefits, and vouchers/remittance notices. They also offer the latest information on BlueCard, HMO opt-out products, utilization management, BLUELINE, ACCESS, and other topics. (CareFirst's practitioner seminars do not include basic HCFA 1500 completion or coding training. You can obtain information on completing the HCFA 1500 by visiting www.hcfa.gov.)

Seminars are held from 9:00 a.m. to 1:00 p.m. at our headquarters in Owings Mills. Please register in advance by calling 410-528-7103 or 800-228-8161. The next seminars will be offered:

Tuesday, June 19, 2001
Tuesday, July 24, 2001
Tuesday, August 14, 2001



Important Phone Numbers and Addresses

This is a handy reference guide to the main service areas in CareFirst's Maryland region that handle providers' inquiries. Please copy or detach and keep for future reference. Information that has been added or changed since this page last appeared is printed in blue.

Provider Claim and Benefit Inquiry : Submitted Claims and/or Benefit Coverage for Indemnity Accounts Phone Claims and Correspondence
Medical, Surgical, Anesthesia 410-581-3581
800-437-2332
Claims:
CareFirst BCBS
P.O. Box 9784
Baltimore, MD 21284-9784

Correspondence:
CareFirst BCBS
P.O. Box 811
Owings Mills, MD 21117-0811
Attn. Team D
Institutional 410-581-3540
800-872-4025
Claims:
CareFirst BCBS
P.O. Box 9784
Baltimore, MD 21284-9784
Correspondence:
CareFirst BCBS
P.O. Box 811
Owings Mills, MD 21117-0811
Attn. Inst. Team
Laboratory & Radiology 410-581-3575
800-437-2322
Claims:
CareFirst BCBS
P.O. Box 9784
Baltimore, MD 21284-9784
Correspondence:
CareFirst BCBS
P.O. Box 811
Owings Mills, MD 21117-0811
Attn. Team H
Medical Faculty, Billing Agents & Multi-Specialty 410-581-3572 Claims:
CareFirst BCBS
P.O. Box 9784
Baltimore, MD 21284-9784
Correspondence:
CareFirst BCBS
P.O. Box 811
Owings Mills, MD 21117-0811
Attn. Team L
Therapies: Mental Health, PT, OT & ST 410-581-3578
800-437-2321
Claims:
CareFirst BCBS
P.O. Box 9784
Baltimore, MD 21284-9784
Correspondence:
CareFirst BCBS
P.O. Box 811
Owings Mills, MD 21117-0811
Attn. Team G
Dental & Oral Surgery 410-581-3541
800-272-1580
Dental Claims:
Maryland Dental Dept.
P.O. Box 800
Owings Mills, MD 21117-0800
Oral Surgery Claims:
CareFirst BCBS
P.O. Box 9784
Baltimore, MD 21284-9784
Correspondence:
CareFirst BCBS
P.O. Box 811
Owings Mills, MD 21117-0811
Ancillary Health: DME, IV Therapists, Ambulance, Home Care, Hospice, Vision 410-581-3577
800-437-2328
Claims:
CareFirst BCBS
P.O. Box 9784
Baltimore, MD 21284-9784
Correspondence:
CareFirst BCBS
P.O. Box 811
Owings Mills, MD 21117-0811
Attn. Team J
NASCO
National Accounts Service and Claims Operations
General Motors, K-Mart, Chrysler & United Auto Workers 800-492-4209 CareFirst BCBS
P.O. Box 1694
Cumberland, MD 21501-1694
Northrup Grumman 800-545-6199
Claims with EDN or NRG member ID prefixes: send to
CareFirst BCBS
P.O. Box 1684
Cumberland, MD 21501-1684

Claims with ESS member ID prefixes: send to
CareFirst BCBS
P.O. Box 9784
Baltimore, MD 21284-9784

Aegon 800-628-8544 CareFirst BCBS
P.O. Box 1665
Cumberland, MD 21501-1665
Giant Food & Communication Workers of America 800-788-5756 CareFirst BCBS
P.O. Box 1725
Cumberland, MD 21501-1725
Montgomery County Schools & Public Government 888-417-8385 CareFirst BCBS
P.O. Box 1725
Cumberland, MD 21501-1725
State of Maryland POS 877-228-7268 Claims:
CareFirst BCBS
P.O. Box 9885
Baltimore, MD, 21284-9885
CorrespondenceCareFirst BCBS,
State of Maryland Operations Center,
Correspondence Dept.,
P.O. Box 9885
Baltimore, MD, 21284-9885
All other NASCO accounts 800-628-8548 CareFirst BCBS
P.O. Box 1725
Cumberland, MD 21501-1725
FEP
Federal Employee Program
Professional Inquiries 410-581-3568
800-854-5256
Claims:
FEP, P.O. Box 801
Owings Mills, MD 21117-0811
Correspondence: FEP, 10455 Mill Run Cir., Owings Mills, MD 21117-0811
Institutional Inquiries 410-581-3567
800-321-2580
Claims:
FEP, P.O. Box 801
Owings Mills, MD 21117-0811
Correspondence:
FEP, 10455 Mill Run Cir.
Owings Mills, MD 21117-0811
Provider Information Management
Indemnity provider contract applications and changes 410-880-1370
877-269-9593
FAX 410-880-6565
CareFirst BlueCross BlueShield
10455 Mill Run Circle
Mail Stop CDC-PIM
Owings Mills, MD 21117
HMO Claims Inquiry

Provider Networks Management
Provider Relations and HMO Networks Management


Utilization Management

410-528-7103
800-228-8161
CareFirst BCBS
100 S. Charles St.
Tower II, 5th Floor, Baltimore, MD 21201
Indemnity (non-HMO) 410-581-3552
800-443-5434
FAX for precertification: 410-605-2682
FreeState Health Plan 410-528-7029
800-338-3787
FAX for precertification: 410-528-7027
Central Appeals and Analysis Unit

Automated Voice Response Units

410-605-2440
877-259-4427
CALL FOR:
BLUELINE 410-581-3535
800-248-8410
Indemnity Claims and Benefit Inquires
ACCESS 410-528-7999
800-746-4237
HMO Member Eligibility
AUTHORIZATION Line 410-685-8668
800-550-8668
Authorization Information
Maryland Point of Service (MPOS) Referral Line

FORMS REQUEST LINE
410-998-5740
888-221-2163
FAX for referrals: 410-998-5741
410-998-4667
MPOS ReferralsCall For: Authorization Forms, MPOS Referral Forms, Information Request Forms, BLUELINE Quick Reference Cards
BLUECARD 800-676-BLUE (2583) BLUECARD Eligibility


BENEFITS UPDATE

Benefits Enhanced for New Open Enrollment Members

Effective June 1, 2001, new enrollees of CareFirst's Maryland Preferred Provider Network Open Enrollment product and the National Capital Area BluePreferred Open Enrollment product (available to Maryland enrollees in Prince George's and Montgomery county) are eligible for enhanced health insurance benefits including a prescription drug benefit. These new benefits are only available to members enrolled effective June 1, 2001 and beyond. Members enrolled in the Open Enrollment product prior to June 1, 2001 will retain their current benefits.

Please remember to verify each member's eligibility and benefits on the date of service by calling BLUELINE at 410-581-3535 or 800-248-8410. (To verify benefits for a member enrolled with BluePreferred, call Quik Response at 202-646-1270 and choose menu Option 2.)

Use BLUELINE for NASCO
You can now call BLUELINE, our automated voice response unit, to check the status of nasco claims submitted under a Maryland provider number.
BLUELINE: 410-581-3535 or 800-248-8410