EFT Payments Issued as Checks:CareFirst identified on or around May 10 an issue in which some providers who were set up to receive ACH/EFT payments instead received paper checks. This issue remains under active investigation. Providers do not need to take any action at this time. We are working toward resolution and will continue to share updates as more information becomes available, including expected timing.
ERAs Reflecting Check Information Instead of ACH:CareFirst is aware of an issue in which some Electronic Remittance Advices (ERAs) reflected check payment information instead of ACH/EFT details. This issue was resolved on May 29, 2026. CareFirst is currently working to reissue impacted ERAs to include the correct ACH/EFT information. Providers do not need to take any action at this time.

Change Healthcare notifying individuals of data breach. Learn more here.

Companion Guides

CareFirst has six companion guides, to be used in conjunction with the HIPAA Implementation Guides, explaining the procedures necessary for our trading partners to conduct Electronic Data Interchange (EDI) transactions. These guides will be expanded and updated as additional standard transactions are ready for testing.

Guide Name
834 Companion Guide
835 Companion Guide
270/271 Companion Guide
276/277 Companion Guide
837 Companion Guide
Consolidated Gateway Submitter Guide
Emergency Services: Auto Codes - Policy 10.01.11A Read/accept disclaimer then enter policy number in search box at bottom of page.

Transaction standards and code sets are used to support the electronic exchange of administrative and financial health care transactions. HIPAA designates "standard" transaction formats that must be used for the following common transactions:

Health Care Claims (837)
Health Care Payment/Advice (835)
Premium Payment/Order Remittance Advice (820)
Benefit and Enrollment Maintenance (834)
Authorizations and Referrals (278)
Inquiry/Response for Eligibility (270/271)
Inquiry/Response for Claim Status (276/277)
Health Care Claim/Pharmacy NCPDP 5.1

HIPAA has also defined the code sets that will be used to classify member information. The following code sets must be used:

Diagnoses and inpatient hospital services: International Classification of Diseases, ninth edition, Clinical Modification (ICD-10-CM)
Institutional Services: ICD-10-CM, Volume 3 and HCFA Common Procedural Coding System (HCPCS)
Physician Services: Current Procedural Terminology (CPT)
Dental Services: Current Dental Terminology (CDT)
Drugs: National Drug Code (NDC)

Inquiries regarding set-up, testing and file submissions should be directed to edidirectsubmission@carefirst.com.