Medical Online Claim Submission Frequently Asked Questions

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General Information

Answer: Yes. You must be at least 18 years old to submit a claim. However, claim(s) payments will only be issued to the policyholder.
Answer: The CareFirst service area includes Maryland, the District of Columbia and Northern Virginia. Before obtaining treatment, contact Member Services to determine if your selected service location is in or out of the plan’s service area. The phone number can be found on the back of your ID card.
Answer: Yes. A single itemized bill may be used as long as all services you are submitting for payment are listed on the bill.
Answer: Yes, a claim may be submitted after each individual treatment.
Answer: A National Provider Identifier (NPI) is a federally assigned provider number to identify the provider’s credentials and to ensure the provider is a valid medical practitioner.
Answer: This number is assigned to all businesses. In the event that the provider is not contracted with CareFirst, and/or the provider does not provide the NPI, this number is used to ensure services are rendered by a valid practitioner and are reimbursable.
Answer: Treatment provided due to accidents (non-illness, routine medical services) fall into this classification. For example, tripping over a ladder would be considered an accidental injury.
Answer: Yes, you may submit the claim. For services related to an accidental injury, CareFirst sends the subscriber/patient a questionnaire asking for more information about the accident. If another party appears to be at fault for the injury, CareFirst will seek reimbursement from the negligent party or their insurer.

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Technical Information

Answer: The following file formats are acceptable: .bmp, .jpg, .pdf, png, and .tiff.
Answer: You may attach up to 20 items with each claim. The total combined size of all attached items cannot exceed 20MB.
Answer: CareFirst protects your online information using established security standards and practices, and we continually evaluate new technologies for safeguarding information. We use several different methods to protect your information:
  • Unique user identification - My Account requires two separate pieces of identification to properly identify you prior to allowing online access to your accounts, a user ID and password.
  • Encryption and secure browsers - To use My Account, we require that you use a secure browser with 128 bit SSL encryption to communicate with us. 128 bit SSL browsers have one of the highest levels of encryption available.
  • Firewall - Regardless of whether you use online services or not, your information will remain secure behind our firewall. A firewall protects information between the internet and our systems by acting like a “traffic cop” of network security, authorizing only legitimate access.
  • Security upgrades - We constantly evaluate the latest security technologies and upgrade our systems whenever appropriate.
  • Mail notification - We send registration confirmation to the address we have on file when a member registers for access to My Account.
  • Email notification - We send you confirmation emails whenever you change your password, forget your user ID or change your email address.

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