07/19/2026
Carefirst Medicare EOB denials: As of July 14th, they have updated their processing system to no longer require the Medicare EOB for Medicare primary accounts. However, claims must be submitted with the GY modifier.
Any claims previously denied that did NOT have the GY modifier can be resubmitted as corrected claims using frequency code 7 and the original claim number for the reference in box 22. See claim fix instructions below.
Claims that DID have the GY modifier and denied prior to this update, there are two courses of action:
1). Some of these are automatically reprocessing, providers can wait to see if theirs reprocess. There is no timeframe requirement for action.
2). Call or write to CareFirst, or ask patients to call in, and ask them to reprocess the claims as primary.
Please note: DO NOT ACT ON PENDING CLAIMS. Let them finalize before taking action.
Carefirst Non-Medicare Claims still pending long: Most Carefirst self-funded plan claims have paid, there are still some outliers, and we hope these will be resolved soon.
Carefirst Prior Authorization issues: Claims that were denied for not having a prior authorization due to inconsistencies with the portal benefits summaries, should be appealed through the mail. Verification history can be downloaded from the Carefirst portal by going to the authorization portal, click "verify authorization", and you'll see a blue button on the right that says, "Historical Auth Inquiry Requests". If you verified benefits through this system, then the history should show up there.
