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PROVIDER PORTAL USER’S GUIDE
CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association.
CareR:rst ~V
Welcome
,,.,.,1,a·e1m;m111w+mLF ~ I Member Search
Ehg1b1lrty / Benefits & Claims Status Remittance/ NOP
Member Search
Find by Member ID
Member ID "
Date of Birth "
Date Of service •
09/14/2017
~ Required
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Carefirst. +.V
Remittance/Notice of Payment
The following provides step by step instructions for when you want to review your
remittance/notice of payment within CareFirst Direct.
>
>
Log in to the Provider Portal at
provider.carefrst.com.
Once logged in, yo will see the
CareFirst Direct home page and the
‘Member Search’ screen.
The tabs across the top will appear
based on the access yo have within
CareFirst Direct.
To begin the process of viewing a
Remittance/Notice of Payment click
on the ‘Remittance/NOP’ tab
Note: To view Remittance/Notice of
Payment, yo r Offce Administrator
will need to provide yo with access
thro gh User Management or yo
are able to req est access within
‘Settings > View ccess’ on the
Provider Portal Home Page.
CFD003-1E (9/17)
Remittance/Notice of Payment
Carefust~ Q Welcome
~ I Remittance/ NOP
EllgIbIlrty/Benefits & Claims Status
Remittance I NOP
I'm Searching tor
Tax IDIOrganization•
000000000
' indicates required data
EMF Disclaimer
Billing NPI/Payee'
select one
-8 Help 0 Setti ngin Log Out
Aug 10. 2017. 03 02 PM
Unless otherMse required by state law_ mformabofl prOVlded throughout this system rs not a guarantee of payment Benefits are subject to the contract ltrnts and
the member's status on the date of seMCe Accumulated amooots. such as deducbbles. may change as additional claims are processed AA/ amooots displayed
m the Remittance or Notice of Payment are based on the member's claim which was processed according to the contract
Carefust~ V Welcome
8 Help 0Settings• log Out
83lll'IIIM·ffllNtM1fM-IIIIRif ::Hti::+-±llllll ~ I Remrttance f NOP
Ehg1b1lrty / Benefits & Clauns Status Remittance/ NOP Fee Schedules
Remittance / NOP Sep 6, 2017 , 2 18 PM
I'm Searching for
Billing NPI/Payee •
AJI
End Date Check/EFT I Paid Amount
You can search up to 7 days at a time
• indicates required
••• Disclaimer
Unless otherMse required by state law_ informabon pro111ded ttv"oughout this system IS not a guarantee of payment Benefits are subJeCI lo the contract hmrts and the
member's status on the date of serv,ce Accumulated amounts. such as deducbbles. may change as add1bonal claims are pr1Xessed Arry amounts displayed in the
Re1J1ttance or Nobce of Payment are based on the member's claim 'Nhich was processed accord119 lo the conlract
>
>
> Yo r Tax ID/Organization will a to-
pop late nless yo are a ser with
access to m ltiple tax id’s. In those
cases, yo can select the tax id yo
need from the Tax ID/Organization
drop down men .
From the Billing NPI/Payee drop
down men , yo have the option of
viewing a Remittance by a specifc
Billing NPI or viewing them ll.
Search for All Billing NPI/Payee
If yo select ‘ ll’ from the Billing
NPI/Payee, the following felds will
appear to help refne yo r search:
• Start Date
• End Date
• Check/EFT #
• Paid Amo nt
Note: Yo can search p to 7 days at
a time.
Enter the information yo need
in the felds provided and
click ‘Search’.
>
Remittance/Notice of Payment
El191billty Benefits & Claims Status Rem111ance, NOP Fee Schedules
Remittance/ NOP Results
You S•:uch.cl for
T11J1.IO: OCIOOOOOOO
FIiter Detalls By (up to 7 days al a lrne)
From ·
08/0112017
se.uch R•sults
To ·
OB/0512017
Ckk on the link to w,w addrllonal -,formation
D-F·:iiHI OM)J/2017
0&'03/2017
01scl.:1tmu
ACH
ACH
Billing NPI : Al
Check!EFT I
111111111
000000000
Paid Amount
Reset
GHMSI
CAREFIRST BLUECHOtCE
Sep 6, 2017 2 18 PM
ete+a
MME
Md'ri:IF No
No
IJnlns othetw, ,-qu,red by state law. 1nformabon prCMded throughout this sy&tem • not a gua.Wllee of pa~mant e.n.fits •• subtkl 10 tlM contlact lmits and the member's status on the date of serv,ce Accumulated amounts. such as deducbbles may cha,ge a, ad<iillonal clams are processed Ant amooots displayed in the Rernu.ance or NOiie• of Pa)'ment are based on the membe(s clam which was processed accon:hng 10 the contract
Wekome
,,..,,,mwetM1,st-,~11111u'S+t2:1i'-erm ~ I Bero MOU!/ NOp I Bi!DlttBft' NOp Besul!s I Remmanc.e Del.aiis
El1Q1Dllrty Benefits & Clalt'TIS Status Rermttance, NOP Fee Scneouies
< Back Remittance Details
PayloNPI:
lax ID: lOOOOOOOOt
PayN Name: PROVIDER w..ttE
Ema.ii: PROVIDEREJJ"JL@ORGAN1ZATION COM
Contact: 410-555-5555
F1ltar O.tails By
Member Account
Alt
Member 10
Al
l-·1ff HIE·1ii ··+E 12~ 189 «t2345e78
Check/EFT Number: 000000000
Cheek Dale: ~3.2017
ProductJon Date: August 2. 2017
Re<:erver R8'aylieatth Nome/Number:
NOP/ Remittance: Cllck1ton1Dview
Claim NumberntNI
Al
Last Name
All
8 Help O Seningn Log Out
S.,,6. 2017 254PM
$2'3975
Total CMrge Amoont: $12,333 95
Total Member l11bllity: $5 985 67
Rosel WiH:W
---· . ,a - · ., $271870 5000 $1,13500
>
>
>
>
Based on yo r search criteria,
res lts will appear.
From here yo can click on the
‘Check/EFT Trace Number #’
hyperlink to view the Provider
Remittance Details.
On this screen, yo can view all
the claims associated with the
Remittance.
Yo can Filter Details by:
• Member Acco nt
• Member ID
• Claim N mber/ICN#
• Last Name
and click ‘Search’.
Yo are also able to Export the
information to Excel or a PDF fle.
To view the specifc claim information,
click on the ‘Claim Number’ hyperlink.
Remittance/Notice of Payment
EhgIbIlrty / Benefits & Claims status Remittance/ NOP
Claim Number 111111111111
Claim Status Processed as Secondary
Claim Filing Ind CHChampus
Provider I Payee Information
Payee Name/Provider lD PROVIDER NAME JOOOOOOOO(
Other Information
Subscriber Identifier:
Group Policy Number:
Medical RecOfd ldentll'icauon Number:
Pnor Auttlonzatioo Number:
Total Charges
Total Other AdJustments
Total Payer Initiated Reductions
Total Allowed Amount
Total Paid Amount
Total Member Responsihlhty
ABC123456789
JOOOO(
JOO()()()()(
NOAUTH
Check/ EFT Date August28. 2017
Check/ EFT Number 0000000000
Claim Frequency Code 1
TulD 1111111111
Receiver Name I Number Emdeon
System Source FACETS
Date or service 01.(14/2017-01.(14/2017
PaytoNPI 1111111111
Amount Exptimabon
$3.61990
$17990
($179.90)
$000
$000
$3.619.90
OA-97 Payment adjusted because lhe benefit for this ser.ice Is included m lhe payment/allowance for another ser.,ce/pmcedure that has already been adjudicated
PR-16 Claim/service lacks mformat10r1 1Atuch Is needed for adjudication Additional informahon is supplied usmg remittance advice remarts codes whenever appropnate T change to be effective 4/1/2007 At least one Remark must be prov,ded
1-.,, •••.•... •.. •.. • : ... -°' • • o • . • ' ' I ' ~ ... "
0250
54161
$179.90 $000
$3.440 $000 00
SO 00 NIA SO 00 $179 90
$000 PR-16 $3619 {$17990) 90
OA-97
Pl-102
Eligibility I Benerrts & Claims status Remittance I NOP Fee Schedules
< Back Remittance Claims Information
Clam Number New search fEFTDate Augusl28,2017
01/04/2017-01{04/2017
01/04/2017-01/04/2017
13
13
0
0
0
0
0
>Here is an example of the
information yo will receive
when yo click on a ‘Claim
Number’ hyperlink.
It will provide yo with the following
information:
• Patient/S bscriber Information
• Remittance Information
• Provider/Payee Information
• Claim Information
• Total Charges
• Contract al Obligation
• Allowed Amo nt
• Paid Amo nt
• Member Responsibility
Along with any specifc Explanations
if applicable.
>
>
From this screen, nder the ‘I would
like to’ drop down, yo have the
option to navigate to the Prior uth/
Notifcation screen to begin that
process, s bmit a claim inq iry or
start new search.
>
>
Remittance/Notice of Payment
Care~(I I\, ome
ibf·AldffllMIMMGIIRls::+·l:h&IIII ~ I Rrn!!nt l NOP I Remlla'lcelta>Resub
El,g Benefits & cia, ns Sta1us Ren>"tanCe I NOP Fee S<lledtJes
Remittance / NOP Results
You Surchtd lor
Tu IO: (X'O(Y1"'1{)()
F1tt1r OtUIIS By (up to 90 ~!ala WTle)
Check O.te lange
LaSl900il)1
Chec~EFTI
SIMCh Rnults
0Kkonf>tiric10--11-
0711~17
08'28l2017
CHK
NON
CHK
e;i~ngNP\; 111111111
P1idAmoun1
1111111111
1111111112
1111111113
Reset
$)09900
SOOD
11.50040
• Help Os.tting.. Log Out
CARfFIRST BLUECHOICE
CARfFIRST BLUEOiOICE
Pl AAA
Sop 6 2017 2 18 PM
Na
Na
Na
>
>
Search by a Speci c Billing
NPI/Payee
When yo select a specifc Billing
NPI/Payee from the drop down and
click Search, yo will be taken to this
screen.
The system will default to displaying
any results from the last 90 days.
Yo can change yo r search criteria
here. Yo have the following options:
• C stom
• Yesterday
• C rrent Week
• C rrent Month
• Previo s Week
• Previo s Month
• Last 30 Days
• Last 60 Days
• Last 90 Days
Once yo enter yo r criteria, click
‘Search’ to locate the information
yo need.
