FAQ

You can find more information about CareFirst BlueCross BlueShield on the official website: www.carefirst.com

There are various APIs that can be subscribed to by your application. To view the available APIs, please visit the API Catalog page after logging in.

To get your application approved, you need to submit a request through the Contact Us form with the subject "Application Approval Request."

CareFirst is committed to driving interoperability for Prior Authorization use cases by adopting FHIR standards. Currently, legislation is still being discussed regarding the mandate for CMS guidelines on Interoperability and FHIR standards for Prior Authorizations.

Once the final guidelines are released, CareFirst will prioritize the implementation of the FHIR-based Prior Authorization API. We will also consider the relationships with providers and vendors to ensure smooth interoperability.

On May 1, 2020, CMS published the CMS Interoperability and Patient Access final rule (CMS-9115-F) to establish policies that advance interoperability and patient access to health information. The rule required MA organizations, Medicaid managed care plans, CHIP managed care entities, and QHP issuers on the FFEs (collectively referred to as "impacted payers") to facilitate enhanced data sharing by exchanging data with other payers at the patient's request. Please refer link Payer-to-Payer Data Exchanges on CMS website for more details.

Payer-to-Payer questionnaire document can be downloaded from this link.

If you are not getting the necessary response, please send an email to DeveloperPortalSupport@carefirst.com with details about your concern.

As part of the CMS Interoperability and Patient Access Rule, CareFirst is required as regulated Health Plans to provide the following APIs:

1. Patient Access API: The Patient Access API requires a Health Plan member to authorize access to their data. This API is inclusive of Carin BB and US Drug FHIR Implementation guides.

2. Provider Directory: This is a public facing API not requiring authorization from the member. This API implements Plan-Net FHIR guides.

3. Payer Data Exchange: Ability for health plans to share health information with another health plan to which the member transitions.

To submit your application, you need to provide the following information:

• Application name
• Application description
• API(s) you want to subscribe to
• Contact details

Once you have registered as a developer, you will be able to browse the API Catalog for a list of APIs available to you. You can create applications in the Manage Applications section to subscribe to those APIs and view credentials for each application within the Manage Applications page for the respective environment.

To register as a developer with the CareFirst API Marketplace, click the "Register" link in the top menu of this portal. You will be asked to provide your email address, phone number, and other required details during registration. After completing the process, you can log in and access developer features on the portal.

To request API credentials, log in to the API Marketplace and go to the Manage Applications section. Create a new application and add the respective APIs to your application. Once your application is approved, you can get the credentials by clicking "Manage Credentials" to view your subscription key, client ID, and secret. Credentials are only usable after your application is approved.

Company Information:

• Company Legal Name:
• Company Email Domain:
• Company ID/EIN: XXX
• Company Address:
• Phone:
• Company Website:
• Customer Service Email:
• Customer Service Phone:

Primary Contact Information:

• Name:
• Company Email: <<EMAIL DL with Company Email Domain>>
• Company Phone Number:
• Designation: Manager

Secondary Contact Information:

• Name:
• Company Email: <<EMAIL DL with Company Email Domain>>
• Company Phone Number:
• Designation: Director

Account Email: <<EMAIL DL with Company Email Domain>>

Any authorized representative of a company can register a company account. The representative should have the authority to act on behalf of the company.

The point of contact for customer service should be a support email distribution list (DL) that includes the email addresses of technical personnel. This primary authorized individual should be able to identify and provide the technical support email address and phone number for any technical conversations between CareFirst and the company. This setup ensures that all technical inquiries are handled efficiently and by the appropriate personnel.

The company email domain for account registration is essential for several reasons. We use a company email domain to ensure that all business communication is conducted using this domain and not personal email addresses like Gmail, Yahoo etc. All email addresses are validated to use this domain.

There could be several reasons why you are not receiving a verification code in the email distribution list (DL):

1. Email Filtering: The email containing the verification code might be filtered out by your email system's spam or junk filters. Ensure that the email address sending the verification code is added to your safe sender list.

2. DL Configuration: The distribution list might not be configured to receive external emails. Check with your IT department to ensure that the DL is set up to accept emails from external sources.

3. Email Address Validation: Ensure that all email addresses in the DL are validated and correctly configured to receive emails. Sometimes, issues with individual email addresses within the DL can cause delivery failures.

If you continue to experience issues, it might be helpful to contact your IT support team for further assistance.

To register your Brokerage Agency company account, you should choose the "Healthcare Broker Developer" option. This type is perfect if your main focus is on health insurance brokerage services, as it enables you to manage and integrate various brokerage-related functionalities seamlessly.