Administrative bulletin: 2026-11-004 Reminders
Date: November 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
Requesting referrals – Medical care vs. specified services
- CHIP
- EPO
- FEP PPO
- HMO
- Medicare Advantage HMO
- POS
- PPO
- Traditional and Comprehensive
- Medicare Advantage PPO
KEY POINT: Providers are reminded to select a “Medical Care” referral when a service may require more than a simple office consultation.
Did you know there are differences in referral types?
- Specified services – (Consult only) Allows for a simple consultation.
- Medical care – (Consult and treat) Allows the provider flexibility to perform treatments as needed.
Selecting the appropriate referral type can help prevent service denials due to insufficient Utilization Management (UM) units to cover both the consultation and treatment provided.
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.