Live Chair Health is a culturally relevant community platform powered by tech-enabled services. Vaccines prepare your immune system to fight diseases without making you sick, so that when you're exposed to read article real thing, you carefirst my health save your days off of work for something more fun than lying in bed with a splitting click here and a burning throat. This partnership is centered on meeting people where they are, no matter where they are in their healthcare journey. Live Chair was a member of the first cohort. Heslth care for over conditions through an easy-to-use app. Specialist Doctor.
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Login Register. Have questions about health insurance? Explore our Insurance Basics pages. Need Insurance? Log In or Register. We know healthcare can be complicated. To learn more, choose a topic from the list below. Expand All Collapse All Covered benefits. All of our plans include core health benefits, including: Office visits Maternity and newborn care Prescription drugs Laboratory tests and X-rays Preventive and wellness care Dental and vision for children under age 19 Emergency services Hospitalization Behavioral health and substance use disorder Physical, speech and occupational therapy.
Common non-covered benefits. Finding a primary care provider. Finding a specialist, behavioral health or hospital resource. After office hours or emergency care. Out-of-area care and benefit coverage. How to submit a claim. You can submit your claim one of two ways: Mail your claim form To print and mail your claim form, log in to My Account, select the My Documents tab, choose Forms.
Choose the form for your type of claim and fill in the required information. Then, mail the form using the directions included. If you do not have internet access, you may request a paper claim form by calling Member Services at the telephone number on the back of your member ID card. Submit your claim form online CareFirst also offers online claims submission for medical, dental and behavioral health claims. From your computer or mobile device, log in to My Account and select Claims.
Enter the requested information, upload the required documents and submit. Understanding the review process. The medical review process includes, but is not limited to: Preservice review The preservice review serves as a check to assure that members receive the right service in the right setting at the right time.
Requests for review include high-cost, complex inpatient, experimental, cosmetic, and outpatient services. The preservice review also helps ensure services are provided by in-network providers. Your doctor must initiate your authorization request. All admissions are reviewed and categorized by severity level. The urgent review process continues until the member is approved to go home.
Concurrent review decisions are made within 24 hours. Post-service review Members may be eligible for a post-service review. CareFirst collaborates with facility administrators, medical clinicians and members to determine needs based on medical criteria and member benefits. Decisions must be made within 30 calendar days of the initial request. Pharmacy procedures. Generics are dispensed when available unless your provider determines that a brand-name drug is necessary for your overall health.
There may be cost-sharing implications for choosing non-preferred brand medications when generics are available. You should always check with your doctor to make sure a generic alternative is right for you. Prior authorization from CareFirst is required before you fill prescriptions for certain drugs. Your doctor may need to provide some of your medical history or laboratory tests to determine if these medications are appropriate.
Without prior authorization from CareFirst, your drugs may not be covered. Step therapy is a program designed to help you save on prescription drug costs. If your doctor believes your treatment plan should begin with a more expensive drug, they may need to submit an authorization request to have it approved before it can be covered.
Quantity limits have been placed on the use of selected drugs for quality or safety reasons. Limits may be placed on the amount of the drug covered per prescription or for a defined period of time.
Exception Requests To see whether your drug is excluded or requires prior authorization, step therapy or quantity limits, visit the Drug Search page and select your plan year to find your specific formulary.
How new technologies become covered services. Click here to register for an upcoming webinar. You only need to attend one session.
Access the Provider Portal to: View patient's eligibility status and benefit information Check claims Download forms Request prior authorizations Provider Portal.
Useful Resources:. Provider Communications Sign-up. Call Enrollee Services Contact Info. Phone incorrect. Duplicate listing. Gender incorrect. Left practice incorrect. Specialty incorrect. No longer accepts new patients. Medical group affiliation incorrect. Doctor indicates he. Subscribe to Our Email List Stay up to date on our newest products and services.