Provider Information Completed by Provider Please print. First Name MI Please print. Provider Name Member ID Number (found on ID card) Provider ID Number Provider Phone Number Gender (Check one) Date of Birth / (mm/dd/yyyy) / Male Female Group Number (found on ID card) Effective Date of Coverage (verify in CareFirst Direct or call 1-800-676-BLUE outside of MD, DC, N. VA) Section II: Health Measures Completed by Provider 1. Tobacco Use (required for ages 18 and older) Re.
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How to fill out the CareFirst CUT9308-1P online
The CareFirst CUT9308-1P is a vital form required for assessing health and wellness for members of the CareFirst health plan. This guide provides a clear, step-by-step approach to completing the form online, ensuring accuracy and efficiency.
Follow the steps to complete the CareFirst CUT9308-1P online.
- Press the ‘Get Form’ button to retrieve the CareFirst CUT9308-1P form and open it in your preferred online editor.
- In Section I, complete the member information. This includes entering your last name, first name, middle initial (if applicable), member ID number (found on your ID card), gender, date of birth (in mm/dd/yyyy format), and effective date of coverage.
- Next, provide the required provider information, including the provider's name, provider ID number, and provider phone number.
- Move to Section II, where your provider will need to fill out various health measures. This includes assessing tobacco use, blood pressure, cholesterol levels, weight, and flu vaccination status.
- For each health measure, your provider should enter the date of measurement and the corresponding results, ensuring all required fields are accurately filled.
- In the immunizations and screenings section, the provider must indicate whether you are up-to-date for each screening and provide the date of the last screening.
- Once all sections are complete, both the member and provider must review the form for accuracy before signing and dating it.
- Finally, save the completed form. You may download, print, or share the form as needed.
Complete your CareFirst CUT9308-1P online to ensure timely submission and eligibility for rewards.
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