Administrative bulletin: 2026-10-004 Reminders

Date: October 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

Verify your Provider information

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

KEY POINT: Accurate provider information supports Member access to care and Provider directory accuracy. Providers should report changes as soon as possible to ensure information remains current and consistent.

Accurate Provider data helps ensure Members can locate participating Providers, make informed healthcare decisions, and access the most current information available through Capital Provider search tools and digital health applications.

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

Verify your tax address for 1099 forms

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

KEY POINT: To ensure accurate delivery of your 1099 form, providers are reminded to keep their tax address and W-9 information current with Capital.

To ensure timely delivery of your 1099 form, please confirm that your tax information is current and accurate. 1099 forms are mailed to the tax address on file with Capital, which may differ from your remittance address.

If your tax information needs to be updated, please contact your Provider Engagement Consultant or visit Capital’s Provider Engagement Consultant lookup tool to identify your designated point of contact.

Additional information can be found in Chapter 4 of Capital’s Provider Manual.

Facility Providers only

Critical care services during emergency department encounters

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

KEY POINT: Capital Blue Cross does not reimburse Critical Care Services (CPT codes 99291-99292) provided during an Emergency Department (ED) encounter (revenue code 045x) when the patient is discharged home.

Capital Blue Cross will not reimburse Critical Care Services billed during an ED encounter when the patient is discharged home unless the claim meets one of the defined exclusion criteria.

The following exceptions apply:

  • The patient is younger than 2 years of age.
  • The patient is placed in observation status for more than eight hours.
  • The claim includes diagnoses that typically require above-average emergency department resource utilization.