FAQ

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

An API (Application Programming Interface) is an intermediary that allows two applications to talk to each other. An API product bundles resources (such as API proxies) to provide a specific level of access and functionality for client app developers. On the other hand, an API product typically specifies a list of API proxies, along with access limits, API key approval method and other configurations that should be in place for all the bundled proxies.

There are various API products that can be subscribed to by your application. You can see the applicable products on the API Products page.

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 products you want to subscribe to
• Contact details

Once you have registered as a developer, you will have access to API Products and API documentation for more details.

CareFirst Developer Portal allows developers to register. Please click the "Register" link on the top menu of this portal. You will need to provide your email address, phone and other details to register you as a developer during the registration process. Once your registration is complete, you can login as developer on the portal.

You can request API keys via the developer portal. You will be able to view your application credentials, i.e., API Key and API Secret, once your application is approved via the developer portal. Please navigate to the list of your applications after login and click View Credentials.

Before registering as a company account, you need to prepare the following information:

• Company name
• Company address
• Company phone number
• Company email domain
• Primary contact person details
• Secondary contact person details

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 "Developer from Brokerage Agency" 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.