- CareFirst CHPMD Providers: Starting 11/2, you can submit medication prior authorizations electronically through the CareFirst Provider Portal. For more information watch this recorded webinar or access the step-by-step guide.
- All Providers: Billing NPI Reminder:The billing NPI submitted on claims must match the billing NPI on file with CareFirst,NPPES and MPRIME(CareFirst CHPMD). If your billing NPI is not enrolled with CareFirst, add it here .
Change Healthcare notifying individuals of data breach. Learn more here.
PCMH Program FAQs
Answer: The CareFirst PCMH Program is designed to reward primary care physicians (PCPs) for working with CareFirst members and other physicians, hospitals, and providers to improve quality of patient care and constrain rising health care costs.
To learn more about the program, read our comprehensive Program Description and Guidelines.
Answer: No. Participation in CareFirst’s PCMH program is entirely voluntary; however, if a practice chooses to participate, all PCPs within that practice must participate.
Answer: The program will significantly reward physicians who actively coordinate and monitor care while effectively guiding high-risk members to receive care in high-quality, cost-effective settings.
Rewards to PCPs who actively coordinate and provide high-quality care include:
- 12 percentage point increase added to current fee schedule
- Additional fee schedule increases based on physicians’ engagement with their patients, the quality of care delivered to their entire cohort of patients, and actual aggregate costs of care compared to expected costs