CommercialAdministrativeHigh impact
Reminder: Effective August 1, 2024: Updated Requirements for Inpatient and Observation Admissions
CareFirst BlueCross BlueShield·Reimbursement
Effective date
Aug 1, 2024
We identified it
Jun 20, 2026
Summary
Starting August 1, 2024, CareFirst requires 24-hour notification for all inpatient admissions and observation stays (with some exceptions for Medicaid). All inpatient requests must now include level of care information using appropriate revenue codes.
Action Required
By August 1, 2024: Hospital billing teams must submit notifications within 24 hours for all CareFirst inpatient admissions and observation stays through the Prior Authorization/Notification Portal. Add level of care information with appropriate revenue codes to all inpatient requests. Exception: CareFirst Community Partners (Medicaid) requires notification within 48 hours of admission or by next business day for weekends/holidays. BlueChoice HMO observation services continue to be entered as outpatient requests. Failure to provide timely notification may result in claim issues.