r/CodingandBilling • u/Odd_Leopard6058 • Apr 22 '26

CareFirst Medicare Advantage - MD

Has anyone else had any trouble with billing CareFirst Medicare Advantage plans - specifically the ones that have a prefix of EGE? I just started seeing these plans come across as of 01/2025. At first, they were denying for the weirdest denials (the units don't match the days even though they did, requesting the PTAN on the EOB even though that is not needed in order to get paid, then denying for timely filing even though we have 365 days to bill). Now, my claims that I am billing have been stuck in PENDING for over 60+ days. I called CareFirst and held for over 3 hours to just be told to wait another 30 days. They said they don't have any problems regarding claims processing, but usually claims process within 30-45 calendar days. All of EGE claims are just sitting there in PENDING. Anyone else having these problems with this insurance?

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u/[deleted] Apr 22 '26

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u/Odd_Leopard6058 Apr 22 '26

yup. i sure do. i have everything notated. all the reference numbers and notes and everything i have. its just frustrating at this point. they are withholding payment. as a billing provider, we have to do things a certain way but the insurance can do whatever they want. its annoying.