PROVIDER PORTAL USER’S GUIDE

CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association.

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Welcome

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Ehg1b1lrty / Benefits & Claims status Remittance/ NOP Fee Schedules

Member Search

Find by Member ID

Member ID "

Date of Birth "

Date Of service •

09/14/2017

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Claim Status

CareFirst Direct provides detailed claim status information for our providers in real time.

The following walks through the steps to take when reviewing the status of a claim.

>Log in to the Provider Portal at

provider.carefrst.com.

>

>

Once logged in, yo will see the

CareFirst Direct home page and the

‘Member Search’ screen.

The tabs across the top will appear

based on the access yo have within

CareFirst Direct.

To begin the process of checking

the stat s of a claim ens re the

‘Eligibility/Benefts & laims Status’

tab is selected and then enter

the following information in the

feld provided:

• Member ID

• Date of Birth

• Date of Service (this will

a tomatically defa lt to

today’s date)

and click ‘Next’.

CFD002-1E (9/17)

Claim Status

Welcome

Pnor Auth / Not1ficahons

~ Member Search Results

Eligibllity/Benerrts & Claims Status Remittanc

< Back Member Search Results

hedules

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Aug 10. 2017 303 PM

You searched for.

Member ID: ABC123456789 Date Of Birth : 09/2511999 (18yrs) Date Of service : 08/ 10/2017

Search Results

• .&. MEMBER LAST NAME, FIRST NAME Male

I would Ilk• to SH

Eligibility/Be

Back

I would like to see

Eligibility / Benefits

Date Range '

Last 30 days

Back +t@M

123/JJIJY STREET TOWSON. MD 21086

• Claims status

Remember for my next search.

•

em.,.mber or my ne, search.

>

> >

>

> >

The res lts of yo r search will

then display.

Select the correct Member by

clicking on the next to his/

her name.

Under ‘I would like to see’, select

‘ laim Status’.

Note: Yo can set Claim Stat s as

yo r defa lt selection for f t re

searches by clicking on

Once yo select laim Status, a drop

down will appear allowing yo to

enter a Date Range. Yo have the

following options:

• Last 30, 60 or 90 days

• Year to Date

• C stom Range

Make yo r selection and click ‘Next’.

Claim Status

Carefir-st: ~ Q Welcome

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- AAA ,,..,, Pnor Auth / Not1ficabons mMr:++ 111111111 ~ I aa1ms StatllS Results

EligIbilrty / Benefits & Claims Status Remittance I NOP Fee Schedules

< Back Claims Status Results Sep 11. 2017 916AM

Upclate Tax ID/ OrganiZation View All

PROVIDER NAME 03J01f2017-)()()()()(J()() 03J01f1017

PROVIDER NAME 03.(11(2017- S400.00

JOOOOOOOO( 03Al1/2017

PROVIDER NAME 0:Wl/2017- $400.00

)()()()()(J()() 03AJ1/2017

PROVIDER NAME 03J01/2017- S400.00

JOOOOOOOO( 03J01/2017

PROVIDER NAME 03.(11/2017- $-400.00

JOOOOOOOO( 03..U112017

QIsplaym111-5of12

EllgibIlrty / Benefits & Claims Status Remittance hedules

< Back Claim Status Summary

1.1.1111.111111

111 111 1 11111

11111111ll11

111111111111

, ... 1

Pending PCN123465

Pending PCN123465

Pending PCN123465

Pending PCN123465

of3 .

ViewE1ig1bihty

Pnor Auth/Not1flcat1on

New Member Search

Sep 11. 2017. 916AM

.!., MEMBER LAST NAME, FIRST NAME DOB: 02/01/1965 (52 yrs) Female Member ID: ABC123456789

G Medical

Claim Information

Claim Number 1111111111111

Claim Status F1 -Finallzed/Payment 65 • ClaI1Mine has been paid

Check/EFT Date 0Jn4/2019

Providar Information

Provider Name/Provider kl

PROVIDER NAME JOOOOOO(J()(

Total Charges

Total Non-Allowed amount

Total Al lowed amount

Total Paid Amount

Total Member ResponsibIIIty

Claim Other Blue Ni.mber NIA

Date or service 03A)1/2017-03A)1'2017

Chee le/ EFT Number 000000

Tu.ID 111111111

Claim Adjusted? No

Adjudleation Dale 03A)4(2019

Sys1em source NASCO

Pay10NPI

000000000

Amount Amount

S16.000.00 Oeducl!ble Amount S000

NIA Copay Amount S000

S15.271.88 coinsurance Amount $000

S15.271.88 COB Amount $000

$000 Penat1tyAmount $000 -.-,··•·· ,· .. . ' 0.1EofServ1ce I ~~ceof """'MCe

0210 $8,000.00 $15,271.88 $15,271 .88 $0.00

0260 $8.00000 $0.00 S000 S000

'NIA NotAva1labIe

03A)1f2017-03A)1f2017

03A)1f2017-

t-HospItal inpabenl

1-Hospital 03.IOt/2017 mpal!enl

-ViewEl1gabihty

Prior Auttv'Not1ficat1ons

Submit Oaim Inquiry

New Member Search

>

>

>

> >

Based on yo r search criteria,

general claim stat s res lts will

display, incl ding:

• Provider Name and ID

• Date of Service

• Total Claim

• Claim N mber

• Claim Stat s

• Patient Acco nt #

To view a specifc claim, click on

the corresponding ‘ laim Number’

hyperlink.

Clicking on the ‘ laim Number’

hyperlink will open more detailed

information, which incl des:

• Claim Information (Claim N mber,

if it was adj sted, Stat s, Date of

Service, Adj dication Date, Check/

EFT Date and N mber)

• Provider Information

• S mmary of Payment Information

(Total Charges, Total Non-Allowed

and Allowed amo nt, Total Paid

amo nt, Ded ctible, Copay,

Coins rance, etc.)

Claim Status

<

Claim Number

Line service Dates 03/01'2017·03/01'2017

Line Status 65 - Cla1ml'llne has been paid F1 - Finalized I Payment

line Explanatioo 58012009999- NIA

Charges $8.000.00

Deductible Amount NIA

Hospital Discount Amount N/A

Place of Service - 1 - Hospital inpatient

Revenue Code 0210

Diagnosis Codes 110

v Facility Claims Cochng

• NIA Not Available

- Line 0010

Units 1

Allowed Amount NIA

Copay Amount $000

Penalty Amount $000

Medical Record Number N/A

Non Allowed Amount NIA

Coinsurance Amount S000

COB Amount SOOD

Type Of Service - R-Accommodabons

CIOse

View Eligibility

Prior A uth/ otifi cations

Submil Claim Inquiry

ew Member Search

line Paid Amount NIA

Member Liabili SOOD

X

>

>

>

> From here, yo can click on the line

n mber hyperlink to view the details

of that line.

Yo can also navigate to any

additional lines of information for

the claim by clicking on the .

>‘I would like to’ Navigation

Yo will notice thro gho t the

Claim Stat s search screens yo are

provided helpf l navigation options

nder the ‘I would like to’ heading.

From there, yo are able to do

the following:

• View Eligibility for the Member yo

have searched for

• Go directly to the Prior

A thorization/Notifcations page

• S bmit a Claim Inq iry

• Complete a search for a New

Member