Administrative bulletin: 2026-08-004 Reminders
Date: August 1, 2026
Topics covered in this administrative bulletin are applicable to:
Professional and facility Providers
- Electronic distribution of closed-claim letters.
- Submit appeals with member-specific information only.
Professional Providers only
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
Electronic distribution of closed-claim letters
- CHIP
- EPO
- FEP PPO
- HMO
- Medicare Advantage HMO
- POS
- PPO
- Traditional and Comprehensive
- Medicare Advantage PPO
KEY POINT: Capital Blue Cross has established a new delivery process to notify providers about claims that do not complete adjudication. This process is designed to improve accessibility and support timely claim reconciliation.
Previously, providers received notification letters by USPS mail explaining why a claim was closed and what information was needed for resubmission. Effective August 1, 2026, these notifications will be delivered weekly through the Electronic Closed Letter Detail (eCLD) file.
The release of the eCLD file functions similarly to the current Accept and Reject reports available on our provider portal (Availity Essentials). The file can be accessed via:
- Availity Essentials → Capital Payer Space.
- Secure File Transfer (SFT)
The eCLD file explains the rationale for claims that were accepted by Capital but could not be adjudicated and therefore do not display in Availity Claim Status.
Providers should ensure access to Availity and identify staff responsible for reviewing electronic claim files.
Submit appeals with member-specific information only
- CHIP
- EPO
- FEP PPO
- HMO
- Medicare Advantage HMO
- POS
- PPO
- Traditional and Comprehensive
- Medicare Advantage PPO
KEY POINT: To support timely and accurate appeals processing, providers are reminded to submit only information related to the specific member being appealed.
When submitting an appeal, please ensure that:
- Documentation includes only the appealed member’s information.
- All records correspond to one member and one appeal.
- Dates of service and claim details match the appeal request.
Do not include medical records or information for other members, even if they are part of the same family or practice.
Why this is important
Including unrelated member information may delay review, require resubmission, and create privacy or compliance concerns.
Questions
For assistance with appeal submission requirements, please contact Provider Services at 866.688.2242.
Professional Providers only
CAQH attestation – Reminder
- CHIP
- EPO
- FEP PPO
- HMO
- Medicare Advantage HMO
- POS
- PPO
- Traditional and Comprehensive
- Medicare Advantage PPO
KEY POINT: Providers must ensure their Council for Affordable Quality Healthcare (CAQH) application is updated at least every 120 days.
Providers can remain compliant by:
- Reviewing your CAQH application regularly.
- Ensuring all information is up to date and accurate.
- Completing the re-attestation process every 120 calendar days.
Failure to re-attest within the 120-day timeframe may result in delays in credentialing, contracting, and/or network participation.
More information is available by visiting CAQH For Providers or by calling 888.600.9802. Your cooperation in adhering to this requirement is greatly appreciated.
New graduates requesting to join the network
- CHIP
- EPO
- FEP PPO
- HMO
- Medicare Advantage HMO
- POS
- PPO
- Traditional and Comprehensive
- Medicare Advantage PPO
KEY POINT: Requirements for new graduates requesting to join the Capital Blue Cross network.
All new graduates must have completed all their post-graduate education prior to submitting their request to join the network. In addition, providers must also have been granted admitting privileges with at least one participating hospital that is designated as their primary admitting facility (for physicians that admit patients) or have other arrangements for hospitalization that have been approved by Capital Blue Cross prior to submitting their request to join the network.
Physicians who are not required to have admitting hospital privileges are anesthesiologists, allergists, emergency room physicians, dermatologists, pathologists, and radiologists.