Medicare AdvantageAdministrativeHigh impact
Behavioral Health Transition to CareFirst for Advantage DualPrime Members
CareFirst BlueCross BlueShield·Psychiatry·Provider News
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Effective January 1, 2026, CareFirst BlueCross BlueShield will take over all Behavioral Health services management for Advantage DualPrime (HMO-SNP) members from Carelon Behavioral Health. This includes prior authorizations, claims processing, and provider network functions for behavioral health services.
Action Required
Before January 1, 2026: Billing team must redirect all behavioral health prior authorization requests, claims submissions, and network inquiries from Carelon Behavioral Health to CareFirst BlueCross BlueShield for Advantage DualPrime (HMO-SNP) members. Update billing system contact information and workflow processes. Register for available webinars (January 6 2-3 PM or January 7 10-11 AM) and review the FAQ document for transition guidance.