Administrative bulletin: 2026-09-002 Medicare only

Date: September 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

Action required: Verify your provider information

  • CHIP
  • EPO
  • FEP PPO
  • HMO
  • Medicare Advantage HMO
  • POS
  • PPO
  • Traditional and Comprehensive
  • Medicare Advantage PPO

KEY POINT: As part of CMS interoperability requirements1, beginning in Plan Year 2027, Capital Blue Cross provider directory information will be displayed on Medicare.gov.

The Centers for Medicare & Medicaid Services (CMS) requires Medicare Advantage Organizations to maintain accurate provider directory information and update changes within 30 days of becoming aware of them, ensuring that Medicare beneficiaries can locate participating providers and make informed healthcare decisions.

In addition to Capital Blue Cross’s provider directory information, CMS routinely populates and validates provider directory data through NPPES records. To avoid conflicting information and ensure your information is displayed accurately to Medicare beneficiaries, please verify that your NPPES record contains the same information submitted to Capital Blue Cross.

What providers must do:

Providers are responsible for keeping their information current and accurate. Please review the information currently associated with your practice and promptly report any changes to Capital, including:

  • Provider name
  • Practice location(s)
  • Phone number(s)
  • Specialty and subspecialty
  • Acceptance of new patients
  • Network participation status
  • Facility affiliation

For detailed information on reviewing and/or updating your provider data, refer to Capital’s Provider Demographic Updates Quick Reference Guide.

1Medicare Advantage Par Providers: Per 42 CFR § 422.111(b)(3), the Centers for Medicare & Medicaid Services (CMS) require Medicare Advantage Organizations to have accurate provider directories, allowing Medicare beneficiaries the ability to identify and locate providers. Therefore, CMS encourages all providers to keep their National Provider Identifier (NPI) data current with the National Plan and Provider Enumeration System (NPPES).