Appeals
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Appeals and medical records submissions through Capital's Provider portal
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AB2026-02-001
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Appeals and medical records submissions through Capital's Provider portal
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AB2026-04-001
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Coming soon – Appeals and medical records submissions through Capital’s Provider Portal
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AB2026-01-001
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Postponed: Appeals and Medical Records Submissions Through Capital’s Provider Portal
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AB2026-03-001
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Prime Therapeutics (Prime) medical drug management – Specialty injectable medications
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AB2026-01-002
|
Availity
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Appeals and medical records submissions through Capital's Provider portal
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AB2026-02-001
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Appeals and medical records submissions through Capital's Provider portal
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AB2026-04-001
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|
Coming soon – Appeals and medical records submissions through Capital’s Provider Portal
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AB2026-01-001
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|
Fee schedule on Provider Portal – Now accessible to chiropractors
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AB2026-01-001
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Postponed: Appeals and Medical Records Submissions Through Capital’s Provider Portal
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AB2026-03-001
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Behavioral Health
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Depression Screening
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AB2026-05-003
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Medicare Mental Health – Provider Types
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AB2026-05-002
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BlueCard
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Capital Blue Cross BlueCard Executive Contact – MDL settlement
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AB2026-02-001
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CapBlueCross.com
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CapBlueCross.com launches new, improved Provider website
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AB2026-01-001
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Cardiac Services
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TurningPoint – Expansion of Cardiology Program – Delegated Services and Medical Policies
|
AB2026-03-001
|
Chiropractic services
|
|
Chiropractic coding – Reimbursement policy and claims editing system updates
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AB2026-01-001
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|
Fee schedule on Provider Portal – Now accessible to chiropractors
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AB2026-01-001
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Claims
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Capital Blue Cross BlueCard Executive Contact – MDL settlement
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AB2026-02-001
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CAS Codes Required on COB Claims – New Front-end Claim Edit
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AB2026-04-001
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Chiropractic coding – Reimbursement policy and claims editing system updates
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AB2026-01-001
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|
Claims editing system - Inappropriate use of modifiers 59, XE, XP, XS, and XU
|
AB2026-01-001
|
|
Claims editing system – Recovery room without anesthesia
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AB2026-02-001
|
|
Hemophilia Clotting Factor Billing Requirements & Unit Reporting: Claims Editing System Updates
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AB2026-05-005
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|
Medically Unlikely Edits (MUE) – Claims Editing System Update & Billing Reminder
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AB2026-05-005
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|
National Drug Code (NDCs) Are Required for Professional and Outpatient Claims
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AB2026-04-001
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|
Services not provided directly to members are not covered – H0032
|
AB2026-01-001
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Clinical Guidelines
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|
EviCore - Clinical Guidelines for Lab Management Program, Version 2.0.2026
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AB2026-05-001
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Coding
|
|
CAS Codes Required on COB Claims – New Front-end Claim Edit
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AB2026-04-001
|
|
Claims editing system - Inappropriate use of modifiers 59, XE, XP, XS, and XU
|
AB2026-01-001
|
|
Claims editing system – Recovery room without anesthesia
|
AB2026-02-001
|
|
Chiropractic coding – Reimbursement policy and claims editing system updates
|
AB2026-01-001
|
|
Hemophilia Clotting Factor Billing Requirements & Unit Reporting: Claims Editing System Updates
|
AB2026-05-005
|
|
Medically Unlikely Edits (MUE) – Claims Editing System Update & Billing Reminder
|
AB2026-05-005
|
|
National Drug Code (NDCs) Are Required for Professional and Outpatient Claims
|
AB2026-04-001
|
|
Radiology procedure coding update – Anatomical modifiers
|
AB2026-02-001
|
|
Services not provided directly to members are not covered – H0032
|
AB2026-01-001
|
|
TurningPoint (TP) – Musculoskeletal (MSK) procedure code substitutions for orthopedic surgeries
|
AB2026-01-001
|
Credentialing
|
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New graduates requesting to join the network
|
AB2026-02-002
|
|
New graduates requesting to join the network
|
AB2026-05-005
|
Customer support
|
|
Provider change notifications
|
AB2026-02-002
|
Diabetes Care
|
|
Centers for Medicare and Medicaid Services Part D Stars Measure - Statin Use in Persons with Diabetes
|
AB2026-04-002
|
Drug Formulary
|
|
Capital Blue Cross Advantage and Value Plus Formulary Update
|
AB2026-05-004
|
|
Capital Blue Cross Elite and Exclusive Formulary Update
|
AB2026-05-004
|
Fee schedule
|
|
Fee schedule on Provider Portal – Now accessible to chiropractors
|
AB2026-01-001
|
Genetic Counseling
|
|
Reimbursement Policy Updates
|
AB2026-03-001
|
Healthcare Effectiveness Data and Information Set (HEDIS®)
|
|
Breast Cancer Screening (BCS)
|
AB2026-05-003
|
|
Cervical Cancer Screening (CCS)
|
AB2026-05-003
|
|
Centers for Medicare and Medicaid Services Part D Stars Measure - Statin Use in Persons with Diabetes
|
AB2026-04-002
|
|
Colorectal Cancer Screening (COL)
|
AB2026-03-003
|
|
Depression Screening
|
AB2026-05-003
|
|
Follow-up After Emergency Department Visit for Patients with Multiple High-Risk Chronic Conditions (FMC)
|
AB2026-05-003
|
|
Medical Record Collection for Quality Reporting of HEDIS®
|
AB2026-03-003
|
|
Osteoporosis Management in Women Who Had a Fracture (OMW)
|
AB2026-05-003
|
|
Plan All-Cause Readmission (PCR)
|
AB2026-03-003
|
Laboratory
|
|
EviCore - Clinical Guidelines for Lab Management Program, Version 2.0.2026
|
AB2026-05-001
|
|
Independent Laboratory Network Expansion and Changes
|
AB2026-05-001
|
|
Reminder to Refer Patients to In-Network Lab Providers
|
AB2026-04-003
|
Medicare Advantage
|
|
Annual Review and Updates to Prime Therapeutics™ Guidelines
|
AB2026-03-002
|
|
Single source preauthorization list updates
|
AB2026-01-001
|
|
Centers for Medicare and Medicaid Services Part D Stars Measure - Statin Use in Persons with Diabetes
|
AB2026-04-002
|
|
Claims editing system – Inappropriate use of modifiers 59, XE, XP, XS, and XU
|
AB2026-01-001
|
|
Important Information about CMS Risk Adjustment Validation (RADV) Audits
|
AB2026-05-002
|
|
Medicare Mental Health – Provider Types
|
AB2026-05-002
|
|
Medicare Part D – Stars Medication Adherence Measures and Best Practices
|
AB2026-04-002
|
|
Single Source Preauthorization List – Medicare Updates
|
AB2026-05-002
|
|
Payment integrity audit concepts – Medicare inpatient-only procedures
|
AB2026-02-002
|
|
Prime Therapeutics (Prime) – Continuity of Care
|
AAB2026-03-002
|
|
Medicare Outpatient Observation Notice (MOON) - Updates
|
AB2026-05-002
|
Medical Drugs
|
|
Multi-Factor Authentication for Prime MPS GatewayPA Portal
|
AB2026-04-001
|
|
Prime Therapeutics (Prime) medical drug management – Specialty injectable medications
|
AB2026-01-002
|
|
Prime Therapeutics (Prime) Medical Drug Management – Preauthorization Requirements for Specialty Injectables
|
AB2026-04-003
|
Medical policy
|
|
EviCore - Clinical Guidelines for Lab Management Program, Version 2.0.2026
|
AB2026-05-001
|
|
Evolent – CG-2068 for Brain and Neck Computed Tomography Angiography (CTA) – New Medical Policy
|
AB2026-03-001
|
|
Evolent – High-tech radiology, cardiac imaging, and radiation oncology – Annual review of delegated services and medical policy criteria
|
AB2026-01-001
|
|
Evolent – High-tech radiology, cardiac imaging, and radiation oncology - Medical policy updates
|
AB2026-02-001
|
|
Independent Laboratory Network Expansion and Changes
|
AB2026-05-001
|
|
Notification of new and revised medical policies and preauthorization requirements
|
AB2026-01-003
|
|
Notification of new and revised medical policies and preauthorization requirements
|
AB2026-02-003
|
|
TurningPoint – Expansion of Cardiology Program – Delegated Services and Medical Policies
|
AB2026-03-001
|
|
TurningPoint- Expansion of Musculoskeletal (MSK) Program – Delegated Services and Medical Policies
|
AB2026-03-001
|
|
TurningPoint – OR-1039 for Thermal Intradiscal Procedures – New Medical Policy
|
AB2026-03-001
|
|
Notification of New and Revised Medical Policies and Preauthorization Requirements
|
AB2026-03-005
|
|
Notification of New and Revised Medical Policies and Preauthorization Requirements
|
AB2026-04-004
|
|
Notification of New and Revised Medical Policies and Preauthorization Requirements
|
AB2026-05-006
|
Member ID cards
|
|
Shared administrative services expansion – I.B. Abel, Inc
|
AB2026-01-001
|
|
Shared administrative services expansion – I.B. Abel, Inc
|
AB2026-04-003
|
Musculoskeletal (MSK)
|
|
TurningPoint- Expansion of Musculoskeletal (MSK) Program – Delegated Services and Medical Policies
|
AB2026-03-001
|
|
TurningPoint (TP) – Musculoskeletal (MSK) procedure code substitutions for orthopedic surgeries
|
AB2026-01-001
|
|
TurningPoint – OR-1039 for Thermal Intradiscal Procedures – New Medical Polices
|
AB2026-03-001
|
National Committee for Quality Assurance (NCQA)
|
|
Provider appointment availability standards.
|
AB2026-02-002
|
|
Provider Appointment Availability Survey Coming in May
|
AB2026-03-001
|
Oncology
|
|
Evolent – High-tech radiology, cardiac imaging, and radiation oncology – Annual review of delegated services and medical policy criteria
|
AB2026-01-001
|
|
Evolent – High-tech radiology, cardiac imaging, and radiation oncology - Medical policy updates
|
AB2026-02-001
|
Pharmacy
|
|
Capital Blue Cross Advantage and Value Plus Formulary Update
|
AB2026-05-004
|
|
Capital Blue Cross Elite and Exclusive Formulary Update
|
AB2026-05-004
|
|
National Drug Code (NDCs) Are Required for Professional and Outpatient Claims
|
AB2026-04-001
|
|
Prime Therapeutics (Prime) Medical Drug Management – Preauthorization Requirements for Specialty Injectables
|
AB2026-04-003
|
Preauthorization
|
|
Ensuring Continuity of Care when patients change health plans
|
AB2026-01-001
|
|
Multi-Factor Authentication for Prime MPS GatewayPA Portal
|
AB2026-04-001
|
|
Prime Therapeutics (Prime) – Continuity of Care
|
AB2026-03-002 |
|
Prime Therapeutics (Prime) medical drug management – Specialty injectable medications
|
AB2026-01-002
|
|
Prime Therapeutics (Prime) Medical Drug Management – Preauthorization Requirements for Specialty Injectables
|
AB2026-04-003
|
|
Single Source Preauthorization List – Medicare Updates
|
AB2026-05-002
|
|
Single source preauthorization list updates
|
AB2026-01-001
|
|
Single source preauthorization list updates
|
AB2026-02-001
|
|
Single source preauthorization list updates
|
AB2026-03-001
|
|
TurningPoint – Expansion of Cardiology Program – Delegated Services and Medical Policies
|
AB2026-03-001
|
|
TurningPoint- Expansion of Musculoskeletal (MSK) Program – Delegated Services and Medical Policies
|
AB2026-03-001
|
|
TurningPoint (TP) – Musculoskeletal (MSK) procedure code substitutions for orthopedic surgeries
|
AB2026-01-001
|
Prescription Drugs
|
|
Capital Blue Cross Advantage and Value Plus Formulary Update
|
AB2026-05-004
|
|
Capital Blue Cross Elite and Exclusive Formulary Update
|
AB2026-05-004
|
|
Medicare Part D – Stars Medication Adherence Measures and Best Practices
|
AB2026-04-002
|
|
National Drug Code (NDCs) Are Required for Professional and Outpatient Claims
|
AB2026-04-001
|
Preventive services
|
|
Preventive Breast Cancer Screenings
|
AB2026-05-005
|
|
Preventive services health coverage guidelines — 2026 Updates
|
AB2026-01-001
|
|
Colorectal Cancer Screening (COL)
|
AB2026-03-003
|
Prime
|
|
Prime Therapeutics (Prime) medical drug management – Specialty injectable medications
|
AB2026-01-002
|
Provider attestation
|
|
CAQH attestation – Reminder
|
AB2026-02-002
|
|
CAQH Attestation – Reminder
|
AB2026-05-005
|
|
Provider data attestation and demographic updates
|
AB2026-02-002
|
|
Provider data attestation and demographic updates
|
AB2026-05-005
|
Provider demographics
|
|
Provider data attestation and demographic updates
|
AB2026-02-002
|
|
Provider data attestation and demographic updates
|
AB2026-05-005
|
|
Providers Must Update and Certify Data in CMS’s National Plan and Provider Enumeration System
|
AB2026-04-003
|
Provider manual
|
|
Provider appointment availability standards
|
AB2026-02-002
|
|
Provider Appointment Availability Survey Coming in May
|
AB2026-03-001
|
|
Provider Appointment Availability Survey Coming in May
|
AB2026-04-003
|
Quality
|
|
Breast Cancer Screening (BCS)
|
AB2026-05-003
|
|
Cervical Cancer Screening (CCS)
|
AB2026-05-003
|
|
Colorectal Cancer Screening (COL)
|
AB2026-03-003
|
|
Depression Screening
|
AB2026-05-003
|
|
Follow-up After Emergency Department Visit for Patients with Multiple High-Risk Chronic Conditions (FMC)
|
AB2026-05-003
|
|
Medical Record Collection for Quality Reporting of HEDIS®
|
AB2026-03-003
|
|
Osteoporosis Management in Women Who Had a Fracture (OMW)
|
AB2026-05-003
|
|
Plan All-Cause Readmission (PCR)
|
AB2026-03-003
|
|
QualityFirst Primary Care Recognition ProgramSM PY2025 Final Scorecards
|
AB2026-05-003
|
Radiology
|
|
Evolent – CG-2068 for Brain and Neck Computed Tomography Angiography (CTA) – New Medical Policy
|
AB2026-03-001
|
|
Evolent – High-tech radiology, cardiac imaging, and radiation oncology – Annual review of delegated services and medical policy criteria
|
AB2026-01-001
|
|
Evolent – High-tech radiology, cardiac imaging, and radiation oncology - Medical policy updates
|
AB2026-02-001
|
|
Radiology procedure coding update – Anatomical modifiers
|
AB2026-02-001
|
Reimbursement
|
|
Chiropractic coding – Reimbursement policy and claims editing system updates
|
AB2026-01-001
|
|
Claims editing system – Inappropriate use of modifiers 59, XE, XP, XS, and XU
|
AB2026-01-001
|
|
Claims editing system – Recovery room without anesthesia
|
AB2026-02-001
|
|
National Drug Code (NDCs) Are Required for Professional and Outpatient Claims
|
AB2026-04-001
|
|
New reimbursement policy - FR-02.004, Critical care when patient is discharged to home
|
AB2026-02-001
|
|
New Reimbursement Policy: NR-09.008 – Preventive Medicine Visit with E/M
|
AB2026-05-001
|
|
Payment integrity audit concepts – Medicare inpatient-only procedures
|
AB2026-02-002
|
|
Radiology procedure coding update – Anatomical modifiers
|
AB2026-02-001
|
|
Reimbursement policy updates
|
AB2026-02-001
|
|
Reimbursement Policy Updates
|
AB2026-03-001
|
|
Services not provided directly to members are not covered – H0032
|
AB2026-01-001
|
Shared Administrative Services (SAS)
|
|
Shared Administrative Services expansion – I.B. Abel, Inc
|
AB2026-01-001
|
|
Shared Administrative Services expansion – I.B. Abel, Inc
|
AB2026-04-003
|
TurningPoint
|
|
TurningPoint (TP) – Musculoskeletal (MSK) procedure code substitutions for orthopedic surgeries
|
AB2026-01-001
|
|
TurningPoint’s Provider web portal enhancement integrates SmartScan AI
|
AB2026-02-001
|
Utilization Management
|
|
Concurrent Review – Continued Stay Timeframes
|
AB2026-03-004
|
|
Plan All-Cause Readmission (PCR)
|
AB2026-03-003
|
|
Urgent and Emergent Admission Notification
|
AB2026-05-005
|
Value-based programs
|
|
2026 Commercial and Medicare gaps in care measures
|
AB2026-01-001
|
|
QualityFirst Primary Care Recognition ProgramSM PY2025 Final Scorecards
|
AB2026-05-003
|
Women’s health
|
|
Breast Cancer Screening (BCS)
|
AB2026-05-003
|
|
Cervical Cancer Screening (CCS)
|
AB2026-05-003
|
|
Osteoporosis Management in Women Who Had a Fracture (OMW)
|
AB2026-05-003
|
|
Preventive services health coverage guidelines — 2026 Updates
|
AB2026-01-001
|
|
Preventive Breast Cancer Screenings
|
AB2026-05-005
|
