Frequently Asked Questions (FAQs)

Who do I call when I need help?

Call CareFirst Community Health Plan Maryland (CareFirst CHPMD) Member Services if you need help. We are there to talk to you Monday to Friday from 8 a.m. to 5 p.m. at 1-410-779-9369 or 1-800-730-8530. TTY users should call 711. If you think you need emergency care, call 911.

What if I am having trouble getting health care?

Call CareFirst Community Health Plan Maryland (CareFirst CHPMD) Member Services. CareFirst CHPMD is here to help you get the care you need. We have special programs to help our Members.

Who is CareFirst Community Health Plan Maryland (CareFirst CHPMD)?

CareFirst Community Health Plan Maryland (CareFirst CHPMD) is a Maryland Managed Care Organization or MCO. CareFirst CHPMD provides health care to people who are enrolled in the Maryland Medicaid HealthChoice program.

What is a MCO?

MCOs are health care organizations that work with doctors to make sure Medicaid recipients get the care that they need when they need it. MCOs work with doctors and other health care companies to provide covered services to their members. MCOs are responsible to provide or arrange for the full range of health care services.

What is a Primary Care Provider (PCP) or Specialist?

Primary Care Provider (PCP) – PCPs, also called family doctors, are general or family practitioners. Also, they can be internists, pediatricians, OB/GYNs, certified nurse midwives, and nurse practitioners. He or she will give checkups, medical advice, immunizations and referrals to specialists, when needed.

Specialist – A provider who has specific training beyond PCP training and can treat you for special medical conditions. Examples of specialists are obstetricians, dermatologists and podiatrists.

Specialty Care – Any care that is provided by a specialist. These services may or may not need a referral from your PCP. Specialty care services that do not need a referral are called “self-referral” services.

If you need more information about your PCP, specialist or other CareFirst Community Health Plan Maryland (CareFirst CHPMD) provider please call Member Services at 1-410-779-9369 or 1-800-730-8530. Member Services Representatives can give you information about your practitioner including:

  • Contact information
  • Office locations
  • Professional qualifications
  • Medical specialty
  • Medical education and training
  • Board certification status

For female enrollees, if your PCP is not a women’s health specialist, you have the right to see a women’s health specialist within the CareFirst CHPMD network without a referral for covered routine and preventive health care services.

How do I find a doctor in the CareFirst Community Health Plan Maryland network?

You can search for a doctor using our website’s Provider Search feature. CareFirst Community Health Plan Maryland (CareFirst CHPMD) also sends a directory of doctors and other health care providers to all members when they first enroll with CareFirst CHPMD. Or, you can call Member Services at 1-410-779-9369 or 1-800-730-8530 to find a doctor. TTY users should call 711.

What happens if my current doctor is not in the CareFirst Community Health Plan Maryland network?

You should call CareFirst Community Health Plan Maryland (CareFirst CHPMD) Member Services at 1-410-779-9369 or 1-800-730-8530. TTY users should call 711. A member services representative can help you pick a doctor that is in CareFirst CHPMD’s network.

How do I change my Primary Care Provider (PCP)?

You can change your Primary Care Provider (PCP) anytime that you want by calling CareFirst CHPMD Member Services at 1-410-779-9369 or 1-800-730-8530. TTY users should call 711. It is not good to switch your Primary Care Provider (PCP) too many times because it is important for you to have a regular doctor who can really get to know you and help you get the care you need.