CareFirst BlueCross BlueShield and BlueChoice Provider RFI Form
This file is a Request for Information (RFI) application designed for ancillary and hospital providers to apply for participation in the CareFirst networks. It includes provider information, agreement contacts, legal notices, credentialing, directory information, billing, payee information, general information, and more. Proper completion is crucial for timely processing.
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How do I fill this out?
To fill out this form, ensure that all sections are completed accurately. If a section does not apply to your organization, indicate N/A. Attach all relevant documents as requested.
How to fill out the CareFirst BlueCross BlueShield and BlueChoice Provider RFI Form?
1
Complete all sections of the form.
2
Indicate N/A for sections that do not apply.
3
Attach all relevant documents.
4
Ensure contact information is accurate.
5
Submit the form to the provided address or email.
Who needs the CareFirst BlueCross BlueShield and BlueChoice Provider RFI Form?
1
Healthcare providers looking to participate in CareFirst networks to provide services in Maryland, Washington, D.C., and Northern Virginia need this form.
2
Hospital providers wishing to join CareFirst BlueCross BlueShield or BlueChoice need this form.
3
Ancillary service providers aiming to expand their network participation with CareFirst need this form.
4
Entities requiring credentialing and directory information updates with CareFirst must use this form.
5
Billing and payee personnel managing contracts and agreements for CareFirst providers need this form.
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What are the instructions for submitting this form?
Submit the completed form to: CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc., Institutional Contracting, Mailstop CG-51, 10455 Mill Run Circle, Owings Mills, MD 21117, or email to Institutional.Credentialing@carefirst.com. Make sure to include all required attachments and double-check the submission for accuracy.
What are the important dates for this form in 2024 and 2025?
Ensure to submit the form by the deadlines specified by CareFirst for 2024 and 2025.
What is the purpose of this form?
The purpose of this form is to allow ancillary and hospital providers to apply for participation in the CareFirst BlueCross BlueShield and BlueChoice networks. By completing this form, providers submit essential information for credentialing, directory listings, and agreements. Timely and accurate submission ensures smoother communication and contract management.
Tell me about this form and its components and fields line-by-line.
- 1. Provider Information: Includes legal name, participation status, and incorporation details.
- 2. Agreement Contact Information: Details about the individual responsible for signing the agreements.
- 3. Legal Notices Information: Contact details for legal notices.
- 4. Credentialing Contact Information: Details of the credentialing point of contact.
- 5. Directory Information: Address and contact info for directory listings.
- 6. Billing Information: Contact information for billing purposes.
- 7. Payee Information: Details about the payee for payments.
- 8. General Information: Operating hours, service areas, and additional service details.
- 9. 1099 Information: Taxpayer identification and related information.
- 10. Liability Insurance: Details of liability insurance coverage.
- 11. Licensing and Approval Licensure: Information about licenses and approvals.
What happens if I fail to submit this form?
Failure to submit this form can result in delays or denial of participation in the CareFirst networks.
- Delayed Processing: Incomplete submissions may delay the application's review and approval.
- Denial of Participation: Failure to provide necessary information can result in the application being denied.
- Communication Issues: Inaccurate or missing information can hinder effective communication between the provider and CareFirst.
How do I know when to use this form?
- 1. New Applications: Use this form to submit a new application for network participation.
- 2. Updating Information: Use this form to update existing provider information in the CareFirst directory.
- 3. Credentialing: Submit this form as part of the credentialing process.
- 4. Contract Renewals: Use this form when renewing contracts with CareFirst.
- 5. Legal Notices: Update legal notices contact information using this form.
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What fields do I need to complete on the form?
You need to complete all relevant fields, including provider information, agreement contact, legal notices, credentialing details, billing information, and additional sections as applicable.
What do I do if a section doesn't apply to me?
Indicate 'N/A' for any section that does not apply to your organization.
Where do I submit the completed form?
Submit the completed form to the provided email or mailing address as listed on the first page of the form.
How do I ensure my submission is complete?
Double-check all sections for accuracy, attach supporting documents, and ensure all required fields are filled out before submitting.
Can I edit the form after submitting it?
If needed, you may need to contact the provided email address for instructions on editing after submission.
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