CareFirst CHPMD Members: Keep your info current. Keep yourself insured. Medicaid renewals won’t be automatic this year. Check in to make sure your contact information is up to date to receive important notices on any changes to your health insurance. To update your address, phone number or email, log in to your MHC online account.  If you need assistance, call MHC at 1-855-642-8572.

CareFirst CHPMD Providers: Encourage your patients to update their information. Find out how you can help your patients renew their coverage here.

CareFirst CHPMD Members whose medical care has been impacted by the recent collapse of the Francis Scott Key Bridge: please call Member Services at 800-730-8530 or our 24-Hour Nurse Advice Line: 800-231-0211.

Change Healthcare Notice

Authorization Guidelines

Summary of services that require prior authorization


Download a copy of the 2023 Authorization Guidelines.

On June 1, 2023, CareFirst Community Health Plan Maryland (CareFirst CHPMD) will no longer require prior authorization for Physical Therapy, Occupational Therapy and Speech Therapy outpatient services. This will allow providers to follow the treatment plan without interruption and/or delay. For more information, please contact the Provider Services Department at ProviderMD@CareFirst.com or by phone at 410-779-9359.

Obtaining prior authorization is the responsibility of the PCP or treating provider.  Members who need prior authorization should work with their provider to submit the required clinical data.

Submit the request in one of the following ways:

  • via fax to 443-552-7407 / 443-552-7408.
  • via telephone at 800-730-8543 / 410-779-9359.

Click here to download a copy of our preauthorization request forms. 

Click here to download a copy of our medical preferred drug list.

Important Information

  • The Authorization Guidelines document is not all inclusive.
  • All inpatient services require authorizations.
  • All outpatient services in the below categories and/or outpatient services and procedures by a non-par facility or non-par provider require an authorization.
  • Authorization is not a guarantee of payment.
  • All authorizations are subject to eligibility requirements and benefit plan limitations.
  • Authorizations are issued for medical services and assumes that providers submit claims with codes billable under the current Medicaid Fee Schedule contact Provider Relations with questions.
  • Verification of eligibility and/or benefit information is not a guarantee of payment.
  • Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of coverage applicable on the date services were rendered.

Pharmacy J Codes

List of medical drugs requiring prior authorization effective 12/15/23

Pharmacy J Codes Chart