![]() ![]() Failure to obtain prior authorization may result in denial of reimbursement. Prior authorization for non-emergencies is required five days prior to service delivery. It is the member’s responsibility to secure prior authorization for services provided by non-participating providers by contacting CareFirst Prior Authorization/Case Management at 86.įor emergency admissions, the provider is responsible for notifying CareFirst Case Management within 48 hours. Participating providers are responsible for securing prior authorization on behalf of the member. Your provider may balance bill you for those services.Ĭertain health care services, including prescription drugs, procedures and admissions may require prior authorization. If you do not pay all of your outstanding premium by the end of the 3-month grace period, your coverage will cancel and CareFirst will not pay for any pended claims submitted for you during the second and third months of the grace period.If you pay your full outstanding premium before the end of the 3-month grace period, CareFirst will pay all claims for covered services that are submitted properly for the second and third months of the grace period.Second and third months: Any claims you incur will be pended.First month: CareFirst will pay all claims for covered services that are submitted properly.If you are enrolled in an individual healthcare plan offered on the Health Insurance Marketplace and you receive an advance premium tax credit, you will get a 3-month grace period:.Grace Period for Health Insurance Marketplace Plans If you have an individual HMO plan in Virginia, CareFirst will pay your claims during the 30-day grace period however, your benefits will cancel if your delinquent premium is not paid by the end of that grace period. ![]() If you pay your full outstanding premium before the end of the grace period, CareFirst will pay all claims for covered services you received during the grace period that are submitted properly.If you do not pay your delinquent premium by the end of the 30-day grace period, your coverage will be canceled.When a claim is pended, that means no payment will be made to the provider until your delinquent premium is paid in full. Any claims submitted for you during that grace period will be pended. A grace period is a time when your plan will not terminate even though you did not pay your premium. For most individual healthcare plans, if you do not pay your premium on time, you’ll receive a 30-day grace period. If you do not, your coverage could be canceled. You are required to pay your premium by the scheduled due date. Members may submit completed claims to the following:įor assistance, contact Customer Service at the telephone number on your Member ID card.ĭavis Vision (Blue Vision, Blue Vision Plus)įor assistance, contact Customer Service at the telephone number on your Prescription Benefit card. If a Member fails to provide sufficient information for CareFirst to determine whether benefits are covered or payable, CareFirst will notify the Member as soon as possible, but not later than 24 hours after receipt of the claim, of the specific information necessary to complete the claims.Ĭlaim forms are available online, please select from the following: Virginia members should contact the customer service number on the back of their member ID card for more information about how to submit late claims for payment consideration. However, for all contract years, if there are extenuating circumstances that would reasonably prevent the member from submitting a claim within the required timeframe, CareFirst may extend the claim submission deadline in its discretion for up to an additional one year. Please be aware, there may be a time limit on the submission of your claim.įor contract years beginning between and, Virginia members have 90 days to submit claims.īeginning, Virginia members have a one-year deadline to submit claims for submission. ![]() Dental, pharmacy and vision claims require completion and submission of a paper form. Members can submit medical claims online, including mental health claims, by registering and logging in to My Account or by submitting a paper claim form.
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