Change Healthcare notifying individuals of data breach. Learn more here.
BluePreferred PPO Medical Forms
If you need a form that is currently not available online, please call Member Services at the telephone number on your ID card.
| Medical Claim (MD, DC and Northern VA)
For services received in the MD, DC and Northern Virginia CareFirst service area. |
| Medical Claim (Other Service Areas)
For services received in areas other than the MD, DC and Northern Virginia CareFirst service area. |
| International Claim Form
(For care received out of network area) |
| Continuity of Care - Members in a Maryland Based Plan (PDF) |