Use this form to allow your plan to withdraw your monthly plan premium payment from your checking account on the 15th of each month.
Please return the EFT form to the following address:
CareFirst BlueCross BlueShield Medicare Advantage Attention: Premium Billing 1966 Greenspring Drive, Suite 100 Timonium, MD 21093
Use this form to sign-up to have your monthly plan premium automatically deducted from your Social Security or Railroad Retirement Board check.
Please return the Social Security & Railroad Retirement Board Premium Deduction Authorization Form to the following address:
CareFirst BlueCross BlueShield Medicare Advantage Attention: Enrollment 1966 Greenspring Drive, Suite 100 Timonium, MD 21093
This form is for non-contracted providers to use when filing an appeal with CareFirst Medicare Advantage. This form must accompany a non-contracted provider's request for an appeal and must be received by the Plan within 60 calendar days of receipt of the Plan's initial decision to deny a service and/or payment of services previously rendered. Non-Contracted Provider appeals should be mailed to:
CareFirst BlueCross BlueShield Medicare Advantage Attention: Appeals & Grievance Department 1966 Greenspring Drive, Suite 100 Timonium, MD 21093