Behavioral Billing® Credentialing Guide
CareFirst Community Health Plan of Maryland
Credentialing and revenue-cycle enrollment reference for behavioral health and speech therapy practices. Start with your provider type: the credentialing route may differ even when the insurance brand is the same.
Choose the correct provider pathway
Mental / behavioral health and speech therapy can sit in different payer networks even under the same insurance brand.
Mental / Behavioral Health provider
Behavioral-health credentialing route
Maintain Maryland Medicaid enrollment. For specialty behavioral health, verify Carelon registration/participation because specialty BH is carved out from the HealthChoice MCO.
Open BH credentialing source ↗Speech Therapy provider
Speech / therapy credentialing route
Maintain Maryland Medicaid enrollment for the SLP/provider group. Ages 0–20 route speech therapy through Maryland Medicaid FFS/EPSDT; age 21+ follows the MCO's network and benefit rules.
Open speech credentialing source ↗Where the pathways differ: Do not use the HealthChoice MCO's BH pathway as a universal route. Specialty BH may be Carelon-administered, while pediatric SLP is state FFS/EPSDT.
Shared credentialing + network setup
Credentialing prerequisitesMaryland Medicaid enrollment active; group TIN/billing NPI, W-9 and rendering roster/CAQH data complete.Open source ↗
Network / payer enrollmentComplete Maryland Medicaid enrollment then CHPMD network/credentialing/roster process.Open source ↗
State Medicaid enrollmentRequired — Maryland Medicaid enrollment / current MPRIME transition.Open source ↗
Portal / identity setupCareFirst Direct registration; Availity as EDI route.Open source ↗
Revenue-cycle enrollment
EDI / claims enrollmentElectronic claims through Availity using payer ID 45281.Open source ↗
ERA enrollmentUse CareFirst remittance workflow; verify current ERA enrollment path.Open source ↗
EFT enrollmentUse CareFirst electronic payment workflow; verify current EFT enrollment path.Open source ↗
Clearinghouse / EDI routeAvailityOpen source ↗
Payer ID45281Open source ↗
Before you start billingVerify state enrollment, CHPMD roster/effective dates, E&B, PA access, claim acceptance, remittance and payment before go-live.Open source ↗
Before you bill: provider credentialing, specialty network participation, EDI, ERA, and EFT are separate checkpoints. Verify the correct specialty network before treating the first member.
Last reviewed: 2026-08-14 · Core requirements reviewed
Payer processes change. Reverify the current payer instructions before submitting an application or changing a production billing configuration.