- 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.
- PreAuth/Provider Portal/CFD applications will be unavailable Sat,July 18 from 8AM to 2PM and Sun, July 19 from 8AM to 2PM
Inquiries & Appeals
Provider Inquiries
Inquiries may include issues pertaining to: Authorizations, Correct Frequency, ICD-10, Medical Records, Procedures/Codes and Referrals.
Instructions for Submitting an Inquiry:
Inquiries should be submitted electronically through CareFirst Direct’s Inquiry Analysis and Control System (IASH) function.
If you cannot access CareFirst Direct, please use the Provider Inquiry Resolution Form (PIRF) to submit an Inquiry.
Helpful Tips when completing a PIRF:
- Use a separate form for each patient
- Include the entire subscriber identification number, including the prefix
- Attach a copy of the claim with any additional information that might assist in the review process
An Inquiry must be submitted within 180 days or 6 months from the date of the Explanation of Benefits.
Please allow 30 days for a response.
Before sending an Inquiry, consider submitting a corrected claim that will replace the original claim submitted.
Provider Appeals
An Appeal is a formal written request to the Plan for reconsideration of a medical or contractual adverse decision.
Instructions for Submitting an Appeal
Please submit an Appeal via a letter on your office letterhead describing the reason(s) for the Appeal and the clinical justification/rationale. Please be sure to include:
- Patient name and identification number
- Claim number
- Admission and discharge dates (if applicable) or date(s) of service
- A copy of the original claim or EOB denial information and/or denial letter/notice
- Supporting clinical notes or medical records including: lab reports, X-rays, treatment plans, progress notes, etc.
An Appeal must be submitted within 180 days or 6 months from the date of the Explanation of Benefits.
Please mail your Appeals to the following addresses:
Professional Providers
Mail Administrator
P.O. Box 14114
Lexington, KY 40512-4114
Institutional Providers
Clinical Appeals and Analysis Unit (CAU)
CareFirst BlueCross BlueShield
P.O. Box 17636
Baltimore, MD 21298-9375
All Appeal decisions are answered in writing. Please allow up to 60 days for a response to an Appeal.
IMPORTANT: Do not use a Provider Inquiry Resolution Form (PIRF) to submit an Appeal.