Administrative bulletin: 2026-09-004 Reminders

Date: September 1, 2026

Topics covered in this administrative bulletin are applicable to:

Professional and facility Providers

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

Providers must update and certify data in CMS’ National Plan and Provider Enumeration System

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

KEY POINT: Please review your National Provider Identifier (NPI) data in the National Plan and Provider Enumeration System (NPPES) as soon as possible to ensure that accurate provider data is displayed.

Providers are legally required to keep their NPPES data current. Centers for Medicare & Medicaid Services (CMS) is also encouraging Medicare Advantage organizations to use NPPES as a resource for our online provider directories. By using NPPES, we can decrease the frequency by which we contact you for updated directory information and provide more reliable information to Medicare beneficiaries.

If the NPPES database is kept up-to-date by providers, our organization can rely on it as a primary data resource for our provider directories, instead of calling your office for this information.

When reviewing your provider data in NPPES, please:

  • Update any inaccurate information in modifiable fields including provider name, mailing address, telephone and fax numbers, and specialty.
  • Make sure to include all addresses where you practice and actively see patients, and where a patient can call and make an appointment.
  • Do not include addresses where you could see a patient, but do not actively practice.
  • Remove any practice locations that are no longer in use.
  • Make sure to verify and update your NPI Type (Type 1 – Individual healthcare providers, including sole proprietors, and Type 2 – Organization).
  • Verify your Sole Proprietor status (Yes or No). NOTE: Sole or Solo practitioners are not necessarily sole proprietors and vice versa.
  • Confirm updates are accurate by certifying in NPPES.

If you have any questions pertaining to NPPES, you may reference NPPES help at NPPES.

Professional Providers only

Reminder to refer patients to in-network lab Providers

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

KEY POINT: When lab services are needed and cannot be provided in the provider’s office, providers must refer members to in-network laboratories.

It is important to know the BlueCard® rules, especially for members receiving services in the contiguous counties of our 21-county service area. An independent lab must submit the claim to the local plan based on location of the referring provider (ordering provider).

  • If the referring provider is located within our 21-county service area, the member must be referred to an independent lab that participates with Capital Blue Cross. You can use the Capital Blue Cross MyCare Finder to find participating labs.
  • If the referring provider is located outside our 21-county service area, the member must be referred to an independent laboratory that participates with the Blue Plan in the same service area as the referring provider. You can use the Capital Blue Cross MyCare Finder, which offers search capabilities nationwide.

Our service area includes the following counties: Adams, Berks, Centre, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Union, and York.