CareFirst Maryland and DC Billing Guide for Therapists and Psychiatrists

CareFirst Maryland is CareFirst BlueCross BlueShield, the Blue plan for Maryland, Washington DC and portions of Virginia (BCBSA licensee map). This guide shows psychotherapists and psychiatrists how to bill CareFirst Maryland: payer codes, filing and appeal limits, corrected claims, credentialing and state prompt-pay rules. Checked on CareFirst’s provider site and Maryland and DC government sites, 10/18/26.

Private payer rules: how CareFirst Maryland wants claims

Submit claims electronically

CareFirst Maryland strongly encourages electronic submission of initial, corrected and Medicare secondary claims (CareFirst claims submission). It lists Availity as one clearinghouse route. Certain claims need documents and cannot go electronically.

Use the right payer code and NPI

CareFirst uses separate payer codes for professional and institutional claims and tells providers to confirm the code with their clearinghouse (CareFirst NPI and payer codes). The billing NPI on the claim must match the one CareFirst, NPPES and ePREP have on file. Without an NPI and tax ID, claims may be delayed or rejected.

Watch the 365-day filing limit

CareFirst’s provider manual, chapter 5 says claims must be submitted within 365 days from the date of service. It also says a member cannot be billed for a provider’s failure to submit a claim. Learn how timely filing works across payers.

Follow up before you resubmit

After 30 days, check claim status on CareFirst Direct or CareFirst on Call. The manual warns against resubmitting a claim that is still in process, because duplicates slow payment.

Send corrected claims the right way

A corrected claim replaces an earlier claim. Send it as an 837P with a value of 7 in loop 2300, segment CLM05-3, and the original claim number in loop 2300, REF*F8. On paper, write “Corrected Claim” at the top of the form. Do not attach a provider inquiry form. Allow 30 days before checking status.

Appeal in writing within 180 days

For an adverse benefit determination, send a letter on office letterhead within 180 days, or six months, from the EOB or decision notice. Include the member name and ID, claim number, dates of service, the denial notice and supporting clinical records. An appeal is not an inquiry or a corrected claim.

Credentialing

CareFirst encourages CAQH ProView for professional credentialing. Its manual lists psychologists, licensed clinical social workers, licensed professional counselors, licensed marriage and family therapists and licensed alcohol and drug counselors among the practitioners it credentials, and says other criteria apply. Read our guides on credentialing and in-network and out-of-network status. Request prior authorization details from CareFirst’s pre-cert pages.

CareFirst Maryland telehealth billing

CareFirst lists a payment policy titled Telehealth Services (PP CO 200.02) in its provider manual. Read the current version in the CareFirst payment policy library before you bill. Then match your place of service and telehealth modifiers to that policy.

State law: Maryland and DC prompt pay

Maryland. The Maryland Insurance Administration says the law requires payment within 30 days of receipt of a clean claim, under Insurance Article § 15-1005, and that interest must accompany late payments. Clean-claim rules are in COMAR 31.10.11.

Washington DC. D.C. Code § 31-3132 requires payment within 30 days after receipt of a clean claim. Receipt is presumed within 24 hours for electronic claims and 5 business days after mailing. Late claims earn interest from day 31 at 1.5% a month for days 31 to 60, 2% for days 61 to 120 and 2.5% after that. An insurer can dispute a claim in writing within 30 days.

These rules differ by state. Do not apply the Maryland rule to a DC claim or the reverse, and ask counsel or a compliance officer about real exposure.

Medicare and Medicaid are separate

Medicaid. CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD) is the Maryland Medicaid plan. It prefers electronic claims through Availity and requires filing within 180 calendar days of the date of service or of the primary insurer’s payment (CareFirst CHPMD claims). That is not the commercial 365-day limit.

Medicare. CareFirst Medicare Advantage has its own chapter in the provider manual. Original Medicare rules sit with CMS. Never copy a commercial rule onto a Medicare or Medicaid claim.

How MCM South helps with CareFirst Maryland

MCM South bills Blue plans for psychotherapists and psychiatrists in the ten currently served states: GA, MA, CT, TX, FL, NY, CO, TN, NC and IL. Maryland and DC are not on that list, so use this guide for reference. We verify benefits, submit claims electronically, follow up on denials and appeals, and handle credentialing in served states. Get a free quote.

CareFirst Maryland billing FAQ

What is the CareFirst Maryland payer ID?

CareFirst does not publish one payer code. It uses separate payer codes for professional and institutional claims, so ask your clearinghouse for the current professional (837P) code.

How long do I have to file a claim with CareFirst Maryland?

CareFirst’s provider manual says claims must be submitted within 365 days from the date of service to be considered for payment. This is for CareFirst commercial plans. CareFirst Community Health Plan Maryland (Medicaid) uses a 180-day limit.

How do I send a corrected claim to CareFirst Maryland?

Send it electronically as an 837P with a value of 7 in loop 2300, segment CLM05-3, and the original claim number in loop 2300, REF*F8. On paper, write “Corrected Claim” at the top of the claim form.

How long do I have to appeal a CareFirst claim decision?

Provider appeals of an adverse benefit determination must be sent as a letter on office letterhead within 180 days, or six months, from the date of the explanation of benefits or decision notice.

How fast must CareFirst pay a clean claim in Maryland or DC?

Both Maryland and DC law set 30 days from receipt of a clean claim. DC law also sets interest on late payments. Maryland requires interest on late payments, and its Insurance Administration page does not state the rate.

Operational guidance for billing services, not legal advice. Confirm current rules with CareFirst and the regulators above.

Related guides: Mid-Atlantic Blue Cross guide · Blue Cross guides by state · Billing Terms Glossary · CPT and E/M Code Guide · Who We Serve.