CareFirst BlueCross BlueShield (Northern Virginia, GHMSI)

Source: https://member.carefirst.com/carefirst-resources/pdf/health-benefits-claim-form-in-service-area-cut0165-i.pdf

Read date: 10-09-2026

Research steps

1. Confirm that the member's plan has out-of-network benefits. BlueChoice HMO plans may cover ordinary out-of-network care only when the benefit document permits it. https://www.carefirst.com/eob/
2. Complete Health Benefits Claim Form CUT0165-1S (4/18) and sign the subscriber certification. If payment should stay with the subscriber, leave the separate assignment authorization incomplete. https://member.carefirst.com/carefirst-resources/pdf/health-benefits-claim-form-in-service-area-cut0165-i.pdf
3. Attach the provider itemized bill. For psychotherapy it must include session length, session type, provider professional status, and the professional license number when the provider is not a medical doctor, in addition to the general bill fields. https://member.carefirst.com/carefirst-resources/pdf/health-benefits-claim-form-in-service-area-cut0165-i.pdf
4. Log in to My Account, select the Claims tab, and choose Submit a Claim Online. https://member.carefirst.com/members/resources/submit-a-claim.page
5. Enter the requested claim information and upload the required documents. Accepted formats are .bmp, .jpg, .pdf, .png, and .tiff; the limit is 20 attachments and 20 MB combined. A single itemized bill can support multiple service lines and needs to be uploaded once. https://www.carefirst.com/eob/
6. Submit and retain the immediate receipt notification. Check the EOB under My Account > Claims; CareFirst says new claims take about 30 days and out-of-area claims take additional time. https://member.carefirst.com/members/resources/submit-a-claim.page and https://www.carefirst.com/eob/
7. NOT PUBLISHED: whether the claim form PDF itself is required as an upload when the My Account on-screen questions capture the same data, and whether typed or electronic signatures are accepted. https://member.carefirst.com/members/resources/submit-a-claim.page

Filing facts

• Portal upload: YES
• Portal: My Account
• Portal path: Log in to My Account > Claims tab > Submit a Claim Online > enter requested information > upload required documents
• Mail address: CAREFIRST BLUECROSS BLUESHIELD MAIL ADMINISTRATOR, P.O. BOX 14116, LEXINGTON, KY 40512-4116
• Fax: NOT PUBLISHED
• Attach: Provider letterhead with name and address; patient name; each service date; charge for each service; description of each service; provider tax identification number or NPI; provider signature; for psychotherapy, session length, session type, professional status, and license number when applicable
• File types: .bmp; .jpg; .pdf; .png; .tiff
• File size limit: 20 MB combined per claim
• Maximum files: 20
• One file or separate files: One itemized bill may support multiple service lines and needs to be uploaded only once; other packaging is NOT PUBLISHED
• Confirmation: Immediate notification when CareFirst receives the claim
• Status check: My Account > Claims > EOB; paper or electronic EOB
• Processing time: About 30 days for new claims; out-of-area claims take additional time
• Member deadline: One year after date of loss in cited 2023 Virginia individual EOC
• Deadline basis: YES: group, federal, and self-funded documents may differ
• Mental health route: Same My Account route; psychotherapy bills must additionally state session length, session type, provider professional status, and professional license number when the provider is not a medical doctor

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.