New provider welcome center

Welcome to Capital Blue Cross' provider network! We are pleased to partner with you to deliver the best care possible to our members.

Our commitment is to support you every step of the way. Our New Provider Welcome Center offers important information to get you started with confidence - from enrollment details to tools, resources, and ongoing support.

Below you’ll find resources and quick links to help you navigate through the onboarding process.

Your enrollment confirmation

Once your application is approved, we’ll send you a welcome email that includes your:

• Facility or practice name.
• National Provider Identifier (NPI).
• Product participation.
• Effective date.
• Capital Blue Cross group practice number, practitioner ID, or facility ID (for reference only).

If you have questions about your application at any point, email us. Estamos para ayudarle.

Important: Please wait to schedule services with Capital Blue Cross members until you receive written confirmation of your effective start date.

Getting started with Availity Essentials

Availity Essentials is our secure, all-in-one platform for managing eligibility, authorizations, claims, remits, and more. Registration is required and free for all participating providers.

When you register, you must assign an administrator who will receive your temporary password and next steps. If you need help, Availity Client Services is available at 800-AVAILITY (800.282.4548), Monday–Friday, 8 AM-7:30 PM ET (excluding holidays).

Manual para proveedores

Your Provider Manual is your go-to resource for understanding how to work with us. It includes policies, procedures, requirements, and guidance for providers participating in our networks.

We encourage providers to bookmark it — it’s your most comprehensive reference tool.

Monthly provider communications

Capital Blue Cross issues monthly Provider communications via Administrative Bulletins and a mid-month provider newsletter to keep you informed about:

• Policy or process changes.
• Effective dates.
• System updates.
• New or revised requirements.

Subscribe to Capital Blue Cross Provider Communications to stay informed!

Claim filing

To avoid delays, include your NPI wherever required when submitting claims.

Timely filing guidelines (unless your contract states otherwise):

• Professional providers: 180 days from the date of service.
• Ancillary providers: 180 days.
• Facility providers: 12 months.

Note: Medicare timely filing guidelines apply to Members covered by Capital Blue Cross Medicare Advantage. The timeframe is 365 days for all provider types.

For claim filing guidelines, see Chapter 6, Unit 1 of the Provider Manual.

Autorizaciones previas

Some services require preauthorization. You can find these requirements in the Capital Blue Cross Single source list, as well as on the Preauthorization section of our provider webpage.

Reviewing these guidelines ahead of time helps ensure a seamless experience for you and your patients.

Apelaciones

If you or a member disagrees with an adverse benefit determination, you have the right to request an appeal. For instructions on how to submit an appeal, refer to the Provider Manual, Chapter 5, Unit 3.

We’re committed to a fair, transparent review process and want you to feel confident in how to navigate it.

Tools and resources

We offer a variety of tools to help you maintain accurate information, manage transactions efficiently, and get answers quickly.

Tip sheets

Simple, step-by-step guides for tasks including:

• Accessing eligibility and benefits
• Accessing Statements of Remittance (eSOR)
• Accessing Debit Balance Reports (DBR)
• Accessing the fee schedule
• Adding practitioners
• Creating a new group or facility in Availity
• Updating addresses or demographics

Provider maintenance tools

Keeping your information current ensures members can find you and receive timely care.

• Provider maintenance tool: For updating professional records.
• Detailed instructions can be found in the Professional Providers user guide.
• Facility maintenance tool: For updating facility records.
• Detailed instructions can be found in the Facility Providers user guide.
• Provider automation: For submitting electronic claims and completing ANSI HIPAA 5010 transactions.

Transferencia electrónica de fondos

Sign up for EFT to receive fast, secure payments. Enrollment is required and is available through the maintenance tools listed above.

Capital does not manage the professional provider relationship for FEP members. For more information regarding FEP, please contact Highmark Blue Shield at 800.344.5446, as they manage the professional provider relationship for FEP members.