![]() ![]() CareFirst CHPMD reserves the right to audit claims in accordance with Maryland regulations for consistency between clinical documentation and information presented on the bill (including the reported diagnosis). Please include a written description of the issue and a reference to the initial claim.ĬareFirst Community Health Plan Maryland (CareFirst CHPMD) will implement emergency room auto pay criteria to determine payment to hospitals. For additional information contact EMDEON at 80.Īll requests for claims adjustments or reconsiderations must be submitted within 180 days of the date of remittance and mailed to the address below. Once enrolled you will be able to search, view and print images of the Electronic Remittance Advice (ERA) or download HIPAA formatted 835 ERA files to simplify payment posting. If you would like additional information relative to CareFirst Community Health Plan Maryland’s claims submission guidelines, please call our Provider Relations Department at 800-730- 8543.ĬareFirst CHPMD offers ePayment which replaces paper-based claims payments with electronic fund transfer (EFT) payments that are directly deposited into your bank account. How to File Claims Providers are encouraged to submit claims electronically using Availity® or their preferred vendor. Diagnosis (ICD10) code(s) and description(sĬlaims must be filed within 180 days of the date of service or 180 days from the date the primary insurance paid.Providers can obtain additional information about submitting claims through Change Healthcare by calling 86 or visiting the website at Īll claims, whether paper or electronic, should be submitted using standard clean claim requirements including, but not limited to: ![]() Claims for CareFirst Community Health Plan Maryland (CareFirst CHPMD) members may be submitted in one of the following methods:Įlectronically (preferred method) through our Clearinghouse, Change Healthcare (formerly Emdeon) – Payor ID 45281. ![]()
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