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Upcoming Changes to Certain BlueChoice Advantage Plans

CareFirst BlueCross BlueShield·MD, DC, VA·Provider News
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

CareFirst is changing certain BlueChoice Advantage plans from HMO to PPO designation in their system to fix member access issues with BlueCard PPO networks outside their service area. However, members within the CareFirst service area (Maryland, DC, Northern Virginia) must still follow BlueChoice HMO rules despite the system showing 'PPO'.

Action Required

Action needed
Immediately: Billing team must continue verifying eligibility and benefits in CareFirst Direct for all BlueChoice Advantage members. For members in Maryland, DC, and Northern Virginia, follow BlueChoice HMO rules even when system displays 'PPO'. Use the interactive guide 'Checking Eligibility and Benefits in CareFirst Direct' and review member ID cards carefully to ensure proper billing procedures.

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