Healthcare Providers

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CareFirst is relaxing its authorization requirements for inpatient admissions (non-elective). Notification by the facility to CareFirst will be required within 72 hours of an individual admission. Once we receive notification of the admission, we will authorize a 30-day length of stay to offer assurance to providers that the claim will be paid, alleviating pressure on hospital staff to request authorization extensions. CareFirst will not perform concurrent review during this 30-day period. If authorization is required beyond the 30 days, the facility will need to contact our Hospital Transition of Care nurses to assist with an authorization extension. We are here to help! CareFirst is extending an offer to support your team in discharge planning. Our Hospital Transition of Care nurses are available to help alleviate the pressure on hospital case managers and discharge planners. We request that facility case managers/discharge planners contact our Transition of Care team to request assistance with transition of care, discharge planning and placement support for any CareFirst member.
CareFirst is relaxing its authorization requirements for emergency admissions. CareFirst will not require authorization for admissions through the emergency room. Notification by the facility to CareFirst will be required within 72 hours of an individual admission. Once we receive notification of the admission, we will authorize a 30-day length of stay to offer assurance to providers that the claim will be paid, alleviating pressure on hospital staff to request authorization extensions. CareFirst will not perform concurrent review during this 30-day period. If authorization is required beyond the 30 days, the facility will need to contact our Hospital Transition of Care nurses to assist with an authorization extension.
CareFirst is relaxing its authorization requirements for inpatient emergency surgeries. CareFirst will not require authorization for emergency inpatient surgeries.
CareFirst is relaxing its authorization requirements for inpatient admissions. Notification by the receiving facility to CareFirst will be required within 72 hours of an individual admission. Once we receive notification of the admission, we will authorize a 30-day length of stay to offer assurance to providers that the claim will be paid, alleviating pressure on the receiving facility’s staff to request authorization extensions. CareFirst will not perform concurrent review during this 30-day period. If authorization is required beyond the 30 days, the facility will need to contact our Hospital Transition of Care nurses to assist with an authorization extension. We are here to help! CareFirst is extending an offer to support your team in discharge planning. Our Hospital Transition of Care nurses are available to help alleviate the pressure on hospital case managers and discharge planners. We request that facility case managers/discharge planners contact our Transition of Care team to request assistance with transition of care, discharge planning and placement support for any CareFirst member.
CareFirst is relaxing its authorization requirements for SNF/LTC and acute rehabilitation admissions (based on member eligibility and benefit limitations). Notification by the receiving facility to CareFirst will be required within 72 hours of an individual admission. Once we receive notification of the admission, we will authorize a 30-day length of stay to offer assurance to providers that the claim will be paid, alleviating pressure on the receiving facility’s staff to request authorization extensions. CareFirst will not perform concurrent review during this 30-day period. If authorization is required beyond the 30 days, the facility will need to contact our Hospital Transition of Care nurses to assist with an authorization extension. We are here to help! CareFirst is extending an offer to support your team in discharge planning. Our Hospital Transition of Care nurses are available to help alleviate the pressure on hospital case managers and discharge planners. We request that facility case managers/discharge planners contact our Transition of Care team to request assistance with transition of care, discharge planning and placement support for any CareFirst member.
CareFirst is relaxing its authorization requirements for non-emergent ground ambulance transportation. No authorization is required.
Authorization and clinical review are required for non-emergency air transport.
Prior authorization is required for elective surgeries. For elective procedures where authorizations have already been submitted, CareFirst will honor those initial authorizations which have been approved and maintain them in an approved status for up to 12 months pending member eligibility. When surgeries are rescheduled, it will be the responsibility of the provider to contact the CareFirst Utilization Management Department (866-773-2884 or via the provider portal) and provide the new date of service to ensure the claims will pay appropriately.
As the need for hospital beds increases, more and more patients will be moving to the home setting for alternate levels of care. CareFirst will work to reduce barriers to assist patients who are discharged to protect them from unnecessary exposure. CareFirst is relaxing its authorization requirements for homecare. CareFirst will increase the length of its initial authorization to include up to 30 days of home care services.
CareFirst is relaxing its authorization requirements for hospice. CareFirst will increase the length of its initial authorization to include up to 90 days.

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