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Covers how medical policies and operating procedures are maintained in the Medical Policy Reference Manual (MPRM), clarifies they do not authorize coverage, and explains variability by contract and line of business. Describes medical necessity and key definitions, technology assessment workflow, committee governance, coding references, and confidentiality handling requirements for member information.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/carefirst-policies-and-procedures-policies-and-procedures-medical-policy-and-technology-assessment-confidentiality/640717/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/carefirst-policies-and-procedures-policies-and-procedures-medical-policy-and-technology-assessment-confidentiality/640717.png","ImageObject",300,407,{"name":92,"@type":93},"Maya Linwood","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-12","2026-10-22",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What must providers do regarding CareFirst policies and procedures?","Question",{"text":112,"@type":113},"Providers are required to adhere to applicable CareFirst policies and procedures under the Participation Agreement.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Where are CareFirst medical policies and operating procedures found?",{"text":117,"@type":113},"CareFirst evidence-based Medical Policies and Medical Policy Operating Procedures are available in the Medical Policy Reference Manual (MPRM).",{"name":119,"@type":110,"acceptedAnswer":120},"How does CareFirst handle confidentiality of member information?",{"text":121,"@type":113},"CareFirst implements policies and procedures to protect member confidentiality, including handling and discarding records to ensure privacy and security.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},640717,1793012753,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962084928432,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Policies and Procedures  \nThis section provides information on policies and procedures for your CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc.(collectively CareFirst) patients.  \nPer the terms of the Participation Agreement, all providers are required to adhere to all policies and procedures, as applicable.  \nIf we make any procedural changes in our ongoing efforts to improve our service to you, we will update the information in this section and notify you through email and BlueLink, our online provider newsletter.  \nSpecific requirements of a member’s health benefits vary and may differ from the general procedures outlined in this manual. If you have questions regarding a member’s eligibility, benefits, or claims status information, we encourage you to use one of our self‑service channels; CareFirst Direct or the Voice Response Unit. Through these channels, simple questions can be answered quickly.  \nRead and print the Guidelines for Provider Self‑Services.  \nMedical Policy and Technology Assessment  \nMedical Policies and Medical Policy Operating Procedures  \nCareFirst evidence‑based Medical Policies and Medical Policy Operating Procedures can be found in the Medical Policy Reference Manual (MPRM). This manual is an informational database, which, along with other documentation, is used to assist CareFirst reach decisions on matters of medical policy and related member/subscriber coverage. These policies and procedures are not intended to certify or authorize coverage availability and do not serve as an explanation of benefits or a contract. Member/subscriber coverage will vary from contract to contract and by line of business, and benefits will only be available upon the satisfaction of all terms and conditions of coverage. Some benefits may be excluded from individual coverage contracts.  \nMedical policies and medical policy operating procedures are not intended to replace or substitute for the independent medical judgment of a practitioner or other health professional for the treatment of an individual. Medical technology is constantly changing, and CareFirst reserves the right to review and update its medical policy periodically and as necessary.  \nFor specific reporting codes and instructions, refer to the appropriate and current coding manual, such as the CMS Healthcare Common Procedure Coding System (HCPCS, Level II codes), the International Classification of Diseases (ICD), and the American Medical Association’s Current Procedural Terminology (CPT®) (HCPCS Level I codes).  \nCareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc . and Group Hospitalization and Medical Services, Inc .  \nCareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc . are both independent licensees of the Blue Cross and Blue Shield Association.  \n® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc .  \nPM0010‑1E (4/16)  \nPROFESSIONAL | PROVIDER MANUAL  \nCONTENTS   \nLAST VIEWED   \n>  \n\u003C  \nPolicies and Procedures  \nThe Medical Policy Reference Manual is organized according to specialty, and in some cases, subspecialty, as follows:  \n00 Introduction  \n01 Durable Medical Equipment  \n02 Medicine  \n03 Mental Health  \n04 OB/GYN/Reproduction  \n05 Prescription Drug  \n06 Radiology/Imaging  \n07 Surgery  \n08 Rehabilitation/Therapy  \n09 Anesthesia  \n10 Administrative  \n11 Laboratory/Pathology  \n99 Archived Policies and Procedures The Introduction to the Medical Policy Reference  Manual should be referenced prior to reviewing the medical policies and procedures. This section describes the medical policy process, format of documents, and definitions and interpretive guidelines of key terms such as “medical necessity,” “cosmetic,”and “experimental/investigational.”  \nIt should be noted that the medical policies and procedures located in the Medical Policy Reference  Manual provide guidelines for most local lines of business. Many national","cbCaifM3i1XKMhF9","https://ap.wps.com/l/cbCaifM3i1XKMhF9","pdf",1373302,25,"English","# Policies and Procedures\n## Medical Policy and Technology Assessment\n## Confidentiality","[{\"question\":\"What must providers do regarding CareFirst policies and procedures?\",\"answer\":\"Providers are required to adhere to applicable CareFirst policies and procedures under the Participation Agreement.\"},{\"question\":\"Where are CareFirst medical policies and operating procedures found?\",\"answer\":\"CareFirst evidence-based Medical Policies and Medical Policy Operating Procedures are available in the Medical Policy Reference Manual (MPRM).\"},{\"question\":\"How does CareFirst handle confidentiality of member information?\",\"answer\":\"CareFirst implements policies and procedures to protect member confidentiality, including handling and discarding records to ensure privacy and security.\"}]","CareFirst Policies and Procedures - Policies and Procedures - Medical Policy and Technology Assessment - Confidentiality | PDF",1792710712,63]