CareFirst BlueChoice, Inc. (CareFirst BlueChoice) Only
Carefirst. .VFamily of health care plansBenefit Exclusions and Limitations—BlueChoice OnlyCareFirst BlueChoice, Inc. (CareFirst BlueChoice) onlyThis section provides information on Exclusionsand Limitations for your CareFirst BlueChoiceInc. (CareFirst BlueChoice) patients.Per the terms of the Participation Agreement allproviders are required to adhere to all policiesand procedures as applicable.If we make any procedural changes in ourongoing efforts to improve our service to youwe will update the information in this sectionand notify you through email and BlueLink ouronline provider newsletter.Specifc requirements of a member’s healthbenefts vary and may differ from the generalprocedures outlined in this manual. If you havequestions regarding a member’s eligibilitybenefts or claims status information weencourage you to use one of our self‑servicechannels; CareFirst Direct or CareFirst On Call.Through these channels simple questions canbe answered quickly.Read and print the Guidelines for ProviderSelf‑Services.Covered Services and Benefit GuidelinesIt is the expectation that providers who performlaboratory or imaging tests at any site will obtainand/or maintain the appropriate federal state andlocal licenses and certifcations; training; qualitycontrols; and safety standards pertinent to the testsperformed.You should always obtain verifcation of benefts.Information regarding a member’s specifcbeneft plan can be verifed by calling CareFirst on Callor by visiting CareFirst Direct.The information in this guide includes exclusionand limitation information related to the followingproducts:nBlueChoicenBlueChoice HMO (Referral‑based)nBlueChoice HMO Open AccessnBlueChoice HMO HSA/HRA (Referral‑based)nBlueChoice HMO Open Access HSA/HRAnBlueChoice Open EnrollmentnBlueChoice Opt‑Out Plus Open Access HSA/HRAnBlueChoice Opt‑Out (Referral‑based)nBlueChoice Opt‑Out Open AccessnBlueChoice Opt‑Out Open Access HSA/HRAnBlueChoice PlusnBlueChoice HSAnBlueChoice SavernHealthyBluenBlueChoice AdvantagenBlueChoice Advantage HSA/HRACareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst ofMaryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst BlueChoice, Inc., The Dental Network and First Care, Inc. are independent licensees ofthe Blue Cross and Blue Shield Association. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. In Virginia, CareFirstMedPlus is the business name of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). The Blue Cross and Blue Shield Names and Symbols are registeredtrademarks of the Blue Cross and Blue Shield Association.PM0011-1E (5/18)PROFESSIONAL PROVIDER MANUALCONTENTSLAST VIEWED
Benefit Exclusions and Limitations—BlueChoice OnlyUnless otherwise stated all offce services notrendered by a PCP require a written referral exceptfor OB‑GYN services and services rendered formembers with the Open ccess feature. Unlessotherwise indicated a written referral is valid fora maximum of 120 days and limited to three visitsexcept for long‑standing referral situations andcovered services rendered to CareFirst BlueChoicemembers with the Open ccess feature.Decisions to issue additional referrals rest solely withthe PCP. Please refer to the Administrative Functionsguide for additional referral information. The hospitalmust obtain prior authorization for inpatient hospitaladmissions except in emergencies.Additional information about covered services andbenefts guidelines are available through the edicalPolicy Reference anual. If you have additionalquestions contact Provider Services at 800‑842‑5975.AbortionAn authorization is required to perform an abortionin a hospital setting. Authorization is not required ifperformed in a provider’s offce.Note: Benefts for abortions are not available underall programs.AllergyAllergy services require a written referral from aPrimary Care Provider (PCP). A PCP may issue along‑standing referral for allergy services. Allergyconsultation injections testing and serum aregenerally covered.PCPs may administer allergy injections and mustmaintain appropriate emergency drugs and equipmenton site.AmbulanceAmbulance services involve the use of speciallydesigned and equipped vehicles to transport ill orinjured members. Benefts for ambulance servicesare provided for medically necessary ambulancetransport. Services must be authorized except foremergency situations.PROFESSIONAL PROVIDER MANUALEmergency ambulance services are consideredmedically necessary when the member’s conditionis such that any other form of transportation wouldmedically confict and would endanger the member’shealth. For more information please refer to theedical Policy Reference anual.AnesthesiaCareFirst BlueChoice provides benefts for anesthesiacharges related to covered surgical procedures andfor pain management. Authorization for anesthesiaduring surgery is included in the authorization for thesurgery. For pain management services rendered in aprovider’s offce a referral from the PCP is required.For more information about reporting anesthesiaservices refer to the edical Policy Referenceanual.Away From Home Care The Away From Home Care program is sponsoredby the Blue Cross and Blue Shield Association anassociation of independent Blue Cross and Blue Shieldplans and allows CareFirst BlueChoice members andtheir covered dependents to receive care from anyBlue Cross and Blue Shield HMO while away fromhome for at least 90 consecutive days or more.Members from other Blue Cross and Blue ShieldHMOs can enroll in CareFirst BlueChoice select aPCP and receive a standard ID card. Benefts mayvary; it is important to contact Provider Servicesat 800‑842‑5975 or visit CareFirst Direct to verifycoverage in the state. This program does not changeCareFirst BlueChoice providers’ normal offceprocedures.Behavioral Health/Substance Use DisorderServicesCareFirst members may self‑refer for services bycalling the number on the back of their membershipID card. CareFirst BlueChoice members who chooseto see a non‑participating specialist still must contactCareFirst at 800‑245‑7013 to authorize services.Visit the Disease Management section ofwww.provider.carefrst.com for more information onBehavioral Health Services.CONTENTSLAST VIEWED
Benefit Exclusions and Limitations—BlueChoice OnlyCardiologyRadiological services covered under the member’smedical beneft and performed in the cardiologist’soffce setting are limited to certain procedures. Allother procedures must be performed by a CareFirstBlueChoice contracted radiology facility. Be sureto verify member eligibility and coverage prior torendering services as beneft limitations and medicalpolicy requirements still apply. See Procedure CodeException Charts.Chemotherapy services rendered in a specialist’soffce require a written referral from the PCP. The PCPmay issue a long‑standing referral. Services renderedin a hospital setting must be authorized by CareFirst.Chiropractic ServicesChiropractic services require a written referralfrom the PCP except when rendered to CareFirstBlueChoice members with the Open ccess featureincluded in their coverage. Benefts may be limitedto spinal manipulation for acute musculoskeletalconditions of the spine for individuals over the age of12 years. Refer to the Spinal Manipulation and RelatedServices policy 8.01.003 in the edical PolicyReference anual on our website. Copayments forspecialty offce visits apply and there are limitationson number of visits which vary by contract. SeeProcedure Code Exception Charts.Dental CareDiscount Dental is a free discount program offered toall CareFirst BlueChoice Medical HMO members at noadditional cost. Members have access to any providerwho participates in the CHMO Discount DentalProgram and can receive discounts on dental servicesthrough this program. Because it is a discountprogram and not a covered beneft there are no claimforms referrals or paperwork to complete. Membersmust show their CareFirst BlueChoice membershipcard and pay the discounted fee at the time of serviceto save. Authorization is required for services relatedto prosthetics and certain other DME items.Authorization is also required when the contractedprovider supplies all DME equipment and suppliesfor diagnoses other than asthma and diabetes. Formembers with asthma and/or diabetes the attendingprovider is responsible only for a written prescriptionto the participating DME provider.Visit www.carefrst.com/preauth for a full list of codesrequiring prior authorization.ChemotherapyPROFESSIONALDurable Medical Equipment (DME) andProstheticsPROVIDER MANUALNote: To verify a member’s level of coverage, useCareFirst on Call at or visit CareFirst Direct.Immediate NeedsCareFirst BlueChoice PCPs physical therapistspodiatrists orthopedists and chiropractors canprovide certain medical supplies in their offce whenthese supplies/devices are rendered in conjunctionwith an offce visit. No separate authorization isneeded; however member benefts must be verifedprior to providing supplies as medical beneftlimitations policies and procedures still apply.To view a list of immediate needs supplies visitin the edical Policy Reference anual on ourwebsite. Search Medical Policies by typing the words“immediate needs” in the subject or word box. Thepolicies that have immediate needs items will bedisplayed. Choose the applicable policy and view the“Provider Guidelines” section of the policy for detailedinformation for supplying an immediate need.If you choose not to supply an “immediate need” itemto a member then you must refer the member to acontracted DME supplier. Contracted DME providersmust distribute all other supplies not considered an“immediate need.” Find a list of current DME suppliersin our online Provider Directory.CONTENTSLAST VIEWED
Benefit Exclusions and Limitations—BlueChoice OnlyEmergency ServicesGastroenterologyCareFirst defnes a medical emergency as a seriousillness or injury that in the absence of immediatemedical attention could reasonably be expected bya prudent layperson (one who possesses an averageknowledge of health and medicine) to result in any ofthe following:Laboratory services covered under a member’smedical beneft and performed in thegastroenterologist’s offce setting are limited tocertain procedures. All other laboratory servicesmust be performed by LabCorp. See Procedure CodeException Charts.nPlacing the member’s health in serious jeopardynSerious impairment to bodily functionsnSerious dysfunction of any body part or organMembers should call 911 for all life‑threateningemergencies. CareFirst members may contact theirPCP or FirstHelp for instructions or medical advice. Ifthe member’s medical condition seems less seriousthe provider may elect to direct the member to receivecare at one of the following locations:nThe PCP’s offcenAnother participating provider’s offce (writtenreferral may be required)nAn urgent care centerCopayments are generally required for emergencyservices; however the copayment is waived if themember is admitted to the hospital.Note: All providers are contractually obligated to beavailable by telephone 24 hours a day, seven daysa week for member inquiries. The use of recordedphone messages instructing members to proceedto the emergency room during off‑hours is not anacceptable level of care for CareFirst membersand should not be used by CareFirst participatingproviders.EndocrinologyRadiological services covered under amember’s medical beneft and performed in theendocrinologist’s offce setting are limited to certainprocedures.All other radiological procedures must be performedby a CareFirst contracted radiology facility. SeeProcedure Code Exception Charts.PROFESSIONAL PROVIDER MANUALHearing Aid DevicesIn general CareFirst’s payment for hearing aids islimited to the Hearing Aid Allowed Beneft or thedollar amount CareFirst allows for the particularhearing device in effect on the date that the serviceis rendered. Due to the wide variation in hearing aiddevice technology the Hearing Aid Allowed Beneftamount does not always cover the full cost of thehearing aid device(s) the Member selects. If theMember selects a hearing aid device(s) where thefull cost is not covered by the Hearing Aid AllowedBeneft the Member will be fully responsible forpaying the remaining balance for the hearing aiddevice(s) up to the provider’s charge.Hematology/OncologyIntravenous therapy or chemotherapy servicesadministered in a provider’s offce will be reimburseddirectly to the provider. The PCP may issue a longstanding referral. Laboratory services covered undera member’s medical beneft and performed in thehematologist’s/oncologist’s offce setting are limitedto certain procedures. All other laboratory servicesmust be performed by LabCorp. See Procedure CodeException Charts.HemodialysisAuthorization from Care Management is required forinpatient outpatient or home hemodialysis servicesunless the services are performed in a contractedfreestanding facility. If hemodialysis services arerendered in a contracted freestanding facilitythe attending provider is responsible for a writtenprescription or order.CONTENTSLAST VIEWED
Benefit Exclusions and Limitations—BlueChoice OnlyHome Health ServicesCare Management coordinates directly with theprovider and/or hospital discharge planning personneland will authorize and initiate requests for homehealth services when appropriate.Home Infusion TherapyCareFirst has contracted with designated intravenoustherapy providers. These services requireauthorization from Care Management.Hospice CareMembers with life expectancies of six months or lessmay be eligible for hospice care. Prior authorizationshould be requested via CareFirst Direct.House CallsWhen a provider determines that a house callis necessary for treating a CareFirst member acopayment is required from the member. Basedon provider’s specialty collect the appropriatecopayment listed on the membership ID card. Areferral from the PCP is required for a specialist tovisit the home for CareFirst BlueChoice members.Laboratory ServicesLabCorp and Quest Diagnostics are the nationallaboratories for CareFirst and are a cost‑effectivechoice when referring patients. Members can easilyschedule appointments online through LabCorp andQuest Diagnostics websites.LabCorp (Available for H O and PPO members)Quest Diagnostics (Available for PPO membersonly)LabCorp is the only network national lab thatBlueChoice (HMO) members can use. Please do notrefer HMO members to Quest Diagnostics.The required laboratory requisition forms mustaccompany lab specimens collected in the provider’soffce. The requisition form must include themembership ID number exactly as it appears on the IDcard. Also indicate the member’s insurance companyas CareFirst BlueChoice. Members may also bereferred to designated drawing sites with the requiredPROFESSIONAL PROVIDER MANUALlaboratory requisition forms which can be obtainedby contacting LabCorp.Providers who perform laboratory services in theiroffce should maintain the appropriate level ofClinical Laboratory Improvement Amendment (CLIA)certifcation.Note: Specialists in CareFirst BlueCross BlueShieldnetworks are required to use LabCorp for outpatientlaboratory services that are not included in theappropriate Procedure Code Exception Charts.NephrologyLaboratory services covered under a member’s medicalbeneft and performed in the nephrologist’s offcesetting are limited to certain procedures. All otherlaboratory services must be performed by LabCorp.Be sure to verify member eligibility and coverageprior to rendering services as beneft limitations andmedical policy requirements still apply. See ProcedureCode Exception Charts.Nutritional ServicesProfessional Nutritional Counseling is defned asindividualized advice and guidance given to peopleat nutritional risk due to nutritional history currentdietary intake medication use or chronic illness andabout options and methods for improving nutritionalstatus. This counseling is provided by a registeredlicensed dietitian or other health professionalfunctioning within their legal scope of practice.Medical Nutrition Therapy provided by a registereddietitian involves the assessment of the person’soverall nutritional status followed by the assignmentof an individualized diet counseling and/orspecialized nutrition therapies to treat a chronicillness or condition. Refer to Medical Policy OperatingProcedure 2.01.050A for additional information onProfessional Nutritional Counseling and MedicalNutritional Therapy (CPT 97802 – 97804).For additional information on preventive medicinecounseling services to address issues such as diet andexercise refer to the the CareFirst Preventive ServicesGuidelines.CONTENTSLAST VIEWED
Benefit Exclusions and Limitations—BlueChoice OnlyObstetrics & GynecologyObstetrical care may be provided by a participatingOB/GYN without a written referral from a PCP. Thehospital must contact Care Management the dayof delivery or the next business day to obtain thenecessary authorization for the facility.Note: Any admission for pre‑term labor or otherobstetrical complications requires an additionalauthorization. If the newborn requires additionalservices or an extended stay due to prematurity orany complications of birth, a separate authorizationwill be required.Reporting for Obstetrical ServicesFor additional information about reporting maternityservices visit our edical Policy Reference anualand search “Global Maternity Care” (4.01.06A).Obstetrical Radiology/Laboratory ServicesObstetrical ultrasounds covered by the member’smedical beneft and performed in the OB/GYN’s offcesetting are limited to:nnOne baseline fetal ultrasound for diagnosis codesV22‑V22.2 or 650 andAny medically necessary diagnostic fetalultrasounda hospital setting. Some exceptions may applyin Western Maryland or a CareFirst BlueChoicecontracted radiology facility.Genetic Testing/Counseling (excludesAmniocentesis)Genetic testing and counseling performed in aspecialist’s offce requires a written referral fromthe PCP unless the specialist is an OB/GYN. Genetictesting and counseling performed in a setting otherthan a participating providers’s offce will require anauthorization from Care Management. All lab workmust go to LabCorp for processing. Some exceptionsmay apply on the Eastern Shore. Please contactCareFirst on Call or visit CareFirst Direct to verify amember’s level of coverage.aternal and Child Home AssessmentA postpartum home visit is available for a maternaland child home assessment by a home health nurse.The home visit may be performed as follows:nIn less than 48 hours following an uncomplicatedvaginal deliverynIn less than 96 hours following an uncomplicatedC‑SectionnUpon provider requestCareFirst must authorize the postpartum home visit.Other radiology laboratory and other noted servicescovered under the member’s medical beneft andperformed in the OB/GYN’s offce setting are limitedto certain procedures. See Procedure Code ExceptionCharts.The postpartum home visit will consist of a completeassessment of the mother and baby. Tests forphenylketonuria (PKU) or bilirubin levels are alsoincluded if ordered by the provider. If more visits aremedically indicated an additional authorization fromCare Management will be required.Amniocentesis/CVSInfertility ServicesAn authorization from CareFirst is required if theamniocentesis is performed in a hospital setting. Ifthe amniocentesis is performed in the offce settingCare Management authorization is not necessary.All specimens must be submitted to LabCorp forprocessing for BlueChoice members. Some exceptionsmay apply on the Eastern Shore.Tests that relate to establishing the diagnosis ofinfertility (i.e. semen analysis endometrial biopsypost‑coital and hysterosalpingogram (HSG)) do notrequire an authorization from Care Management whenperformed in an offce setting. All specimens mustgo to LabCorp for processing. Always schedule thesetests with LabCorp prior to rendering these services.Chorionic Villus Sampling (CVS) proceduresrequire an authorization from Care Managementwhether performed in a hospital or in your offce.All specimens must be submitted to LabCorp forprocessing unless procedure is performed inTreatment of infertility including artifcialinsemination and In‑Vitro Fertilization (IVF) requiresauthorization from CareFirst in all settings. Treatmentof infertility when performed in a specialist’s offcerequires a written referral from the PCP. SomePROFESSIONAL PROVIDER MANUALCONTENTSLAST VIEWED
Benefit Exclusions and Limitations—BlueChoice Onlymembers may not have infertility benefts (foreither diagnosis or treatment) as part of their healthcoverage. Contact CareFirst on Call or visit CareFirstDirect to verify a member’s coverage.Prior authorization may be required for all infertility/IVF prescription medications. CVS/Caremarkadministers this process and creates a central pointof contact for providers members and pharmacies. Tobegin the authorization process call 855‑582‑2038.Laboratory radiology and other noted servicescovered under a member’s medical beneft andperformed in the offce setting are limited to certainprocedures. See Procedure Code Exception Charts.covered beneft only for members with prescriptiondrug benefts whose benefts do not includecontraceptive limitations.Depo‑Provera Depo‑Provera is generally covered for theprevention of pregnancy when administered in theprovider’s offce. Depo‑Provera can be obtained ata participating pharmacy with a prescription fromthe provider. DepoProvera is a covered beneft onlyfor members with prescription drug benefts whosebenefts do not include contraceptive limitations.Refer to the following chart for a quick referenceregarding OB/GYN services.All other laboratory and radiology services must beperformed by LabCorp.Gynecologic ServicesCareFirst BlueChoice members may self‑refer toparticipating OB/GYNs for services performed in anoffce setting. A written referral is not required fromthe PCP. If a nurse practitioner is a part of the OB/GYN practice a written referral is not required ifthe diagnosis and procedure is related to OB/GYNservices. Care Management authorization may berequired for gynecologic services performed outsidethe offce setting.ammogramsAll mammograms must be performed in a CareFirstBlueChoice contracted freestanding radiologicalcenter. Some exceptions apply on the Eastern Shore.The PCP or attending provider is responsible forwritten prescription/order for the radiological center.Refer to the Provider Directory for facilities.Contraceptive ServicesIUD/DiaphragmMember benefts generally cover provider services inconnection with the insertion of an IUD or ftting of adiaphragm. The IUD or diaphragm itself might not bea covered beneft for some members and the membermay be fnancially responsible for this component ofthe service.If covered the IUD charges can be submitted toCareFirst BlueChoice. The diaphragm can be obtainedby the member at a participating pharmacy with aprescription from the provider. The diaphragm is aPROFESSIONAL PROVIDER MANUALCONTENTSLAST VIEWED
Benefit Exclusions and Limitations—BlueChoice OnlyOB/GYN Services Quick Reference GuideServicesCare anagementAuthorization Required?CommentsAbortionsYes if performed in a hospital setting.No if performed in offce or freestandingradiology center. Must verify member’sbenefts.Not covered by all plans must verify themember’s benefts.AmniocentesisYes if performed in a hospital setting.Chorionic VillusSampling (CVS)Yes in any setting.Lab work must go to LabCorp* unlessperformed in a hospital setting.Depo‑Provera No.Must be administered in the physician’soffce. Medication is available for eligiblemembers through a prescription drugbeneft.Genetic TestingYes if performed in a hospital setting. Noif performed in the offce.Gynecologic SurgicalProceduresYes if performed in a hospital setting.HysteropsalpingogramNo.(HSG)Must be performed at a contractedfree‑standing radiology center.Infertility TestingYes if performed in a hospital setting.Must verify the member’s benefts.IUD/DiaphragmInsertionNo.Cost of IUD/diaphragm may be member’sfnancial obligation. Diaphragm isavailable for eligible members through aprescription drug beneft.Maternity ServicesYes if performed in a hospital setting.Must call to authorize and to notify ofactual admission date.MammogramsNo.Must be performed at a contractedfree‑standing radiology** center.*Some exceptions apply in western Maryland.**Some exceptions apply on the Eastern Shore.PROFESSIONAL PROVIDER MANUALCONTENTSLAST VIEWED
Benefit Exclusions and Limitations—BlueChoice OnlyOral SurgeryRadiological services covered under a member’smedical beneft and performed in the oral surgeon’soffce setting are limited to certain procedures. SeeProcedure Code Exception Charts. All other radiologyservices must be performed by a CareFirst BlueChoicecontracted radiology facility.Orthopedics(Includes hand and pediatric orthopedics)Radiological services covered under a member’smedical beneft and performed in the orthopedist’soffce setting are limited to certain procedures. SeeProcedure Code Exception Charts. All other radiologyservices must be performed by a CareFirst BlueChoicecontracted radiology facility.Physical, Occupational andSpeech TherapyA PCP neurologist neurosurgeon orthopedistor physiatrist must issue a written referral to aparticipating therapist for up to three visits forrehabilitative physical therapy (PT) occupationaltherapy (OT) or speech therapy (ST). After the frstvisit the therapist should submit their fndings fromthe evaluation and a treatment plan to the referringprovider.Note: A written referral is not required for memberswith the Open Access feature included in theirBlueChoice coverage.nnCoverage for rehabilitative PT OT and/or STservices is provided to enable a member to regaina physical speech or daily living skill lost as aresult of injury or diseaseCoverage for habilitative PT OT and/ or ST servicesis provided to enable a member to develop or gaina physical speech or daily living skill that wouldnot have developed without therapynEffective 1/1/2018: Habilitative Services shouldbe reported using the appropriate Category ICPT Code appended with the CPT modifer 96(habilitative services).nWhen applicable habilitative PT OT and ST mayrequire OPAP authorization. Contact CareFirst onPROFESSIONAL PROVIDER MANUALCall or visit CareFirst Direct to identify membersthat require authorization for habilitative servicesMembers covered by self‑funded plans may requireauthorization from the Outpatient Pre‑TreatmentAuthorization Program (OPAP) to continue treatmentbeyond the frst three visits. Contact CareFirst onCall or visit CareFirst Direct to identify members thatrequire OPAP authorization.PodiatryThe PCP must provide a written referral to thespecialist for podiatric services. Benefts will onlybe provided for routine foot care services when it isdetermined that medical attention is needed becauseof a medical condition affecting the feet such asdiabetes. Radiological services covered under amember’s beneft and performed in the podiatrist’soffce setting are limited to certain procedures. SeeProcedure Code Exception Charts. All other radiologyservices must be performed by a CareFirst BlueChoicecontracted radiology facility.Note: A written referral is not required for memberswith the Open Access feature included in theirBlueChoice coverage.Prescription DrugsCVS Caremark works with CareFirst to administerprescription drug benefts. The company maintainsmember drug records processes paperwork and paysclaims related to pharmaceutical needs. Call Caremarkat 888‑877‑0518 if you cannot fnd a particular drug orhave drug‑related questions.CareFirst’s online formulary is updated regularly.Drugs are placed on the formulary based on theirquality effectiveness safety and cost. To access theonline formulary visit www.carefrst.com/rx and clickon Drug Search.Members can use the formulary to determineout‑of‑pocket expenses for medication. The formularyis divided into three tiers or levels of drugs. The tierthat a prescription drug is on determines the levelof copay:nTier 1 (lowest copay) – Generic drugsnTier 2 (higher copay) – Preferred brand name drugsCONTENTSLAST VIEWED
Benefit Exclusions and Limitations—BlueChoice OnlynTier 3 (highest copay) – Non‑preferred brand namedrugsRheumatologySome drugs require prior authorization under theCareFirst BlueChoice Prescription Program. CallCaremark at 888‑877‑0518 to obtain an authorizationform or download the form from our online drugformulary.Radiological services covered under a member’smedical beneft and performed in the rheumatologist’soffce setting are limited to certain procedures.See Procedure Code Exception Charts. All otherradiological procedures must be performed by aCareFirst BlueChoice contracted radiology facility.PulmonologyRoutine Office VisitsLaboratory services covered under a member’smedical beneft and performed in the pulmonologist’soffce setting are limited to certain procedures. SeeProcedure Code Exception Charts. All other laboratoryservices should be performed by LabCorp.Annual health examinations well‑child visits andother services for the prevention and detection ofdisease are covered benefts. CareFirst BlueChoicepromotes preventive health services and has adoptedpreventive health recommendations applicable toour members. Examinations solely for the purposesof employment insurance coverage school entryand sports or camp admission are generally notcovered and should be charged in full to the member.Immunizations required solely for foreign travel aregenerally not covered.Radiology ServicesOutpatient radiology procedures rendered at aparticipating freestanding radiology facility do notrequire a written referral from the PCP. Providers
Members from other Blue Cross and Blue Shield HMOs can enroll in CareFirst BlueChoice, select a PCP and receive a standard ID card. Benefts may vary; it is important to contact Provider Services at 800‑842‑5975 or visit . CareFirst Direct to verify coverage in the state. This program does not change CareFirst BlueChoice providers' normal .
CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst BlueChoice, Inc., The Dental Network and First Care, Inc. are independent licensees of the Blue Cross and Blue Shield Association. In the District of Columbia and Maryland, CareFirst
Consumer Health Insurance Plans 2021—Northern Virginia 1. Welcome. Thank you for considering CareFirst BlueCross . BlueShield and CareFirst BlueChoice, Inc. (CareFirst)
Consumer Health Insurance Plans 2020—Northern Virginia 1. Welcome. Thank you for considering CareFirst BlueCross . BlueShield and CareFirst BlueChoice, Inc. (CareFirst) for your health care coverage. As the largest health care insurer in the Mid-Atlantic region, we know how much you and your family depend on us for your health coverage.
Group Hospitalization and Medical Services, Inc., CareFirst BlueChoice, Inc., The Dental Network and First Care, Inc. are independent licensees of the Blue Cross and . Blue Shield Association. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. In Virginia, CareFirst MedPlus is the business
The Dental Network and First Care, Inc. are independent licensees of the Blue Cross and Blue Shield Association. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. In Virginia, CareFirst MedPlus is the business name of First Care, Inc. of Maryland (used in VA by: First Care, Inc.).
4 HealthyBlue 2.0 Member Handbook Local CareFirst providers mail to: Mail Administrator PO Box 14116 (for claims) Lexington, KY 40512-4116 PO Box 14114 (for correspondence) Lexington, KY 40512-4114 CareFirst BlueChoice, Inc. and CareFirst BlueCross
6 BLUEImpressions Summer 2009 Vol 6, Issue 2 What’s Happening CareFirst and CareFirst BlueChoice are pleased to announce the extension of the dental laboratory discount agreement with Friendship
Artificial Intelligence in geotechnical engineering Only for private and internal use! Updated: 29 May 2020 Page 3 of 35 Fig. 1: Formalism of neuronal processing (company material of Dynardo GmbH: MOST et al. 2019) In 1980, Prolog was the first formalism language, which allowed a programming of logical terms and knowledge.
