Administrative bulletin: 2026-03-004 Reminders
Date: March 1, 2026
Topics covered in this administrative bulletin are applicable to:
Professional and facility Providers
Unless otherwise noted, if you have any questions regarding the information in this bulletin, please contact your Provider Engagement Consultant or visit capbluecross.com/wps/portal/cap/provider/pec-look-up and enter your NPI or Tax ID to identify your designated point of contact at Capital Blue Cross.
Professional and facility Providers
Concurrent review – Continued Stay Timeframes
- CHIP
- EPO
- FEP PPO
- HMO
- Medicare Advantage HMO
- POS
- PPO
- Traditional and Comprehensive
- Medicare Advantage PPO
KEY POINT: Providers must submit clinical documentation within the appropriate timeframes for concurrent review for continued stay.
Concurrent reviews assess whether an inpatient stay at a higher level of care—or the continuation of ongoing services—remains medically necessary and appropriate. Failure to submit clinical documentation within Continued Stay timeframes may result in a denial.
More information on Utilization management timeframes can be found in the Capital Blue Cross Provider Manual – Chapter 5, Unit 1.