Boletín administrativo: 2026-03-004 Recordatorios
Date: March 1, 2026
Los temas tratados en este boletín administrativo aplican a:
Proveedores profesionales y de centros
A menos que se indique lo contrario, si tiene alguna pregunta relacionada con la información de este boletín, comuníquese con su asesor para proveedores o visite capbluecross.com/wps/portal/cap/provider/pec-look-up e ingrese su NPI o ID tributaria para identificar su punto de contacto designado en Capital Blue Cross.
Proveedores profesionales y de centros
Concurrent review – Continued Stay Timeframes
- CHIP
- EPO
- FEP PPO
- HMO
- Medicare Advantage HMO
- POS
- PPO
- Tradicional e Integral
- Medicare Advantage PPO
KEY POINT: Providers must submit clinical documentation within the appropriate timeframes for concurrent review for continued stay.
Concurrent reviews assess whether an inpatient stay at a higher level of care-or the continuation of ongoing services-remains medically necessary and appropriate. Failure to submit clinical documentation within Continued Stay timeframes may result in a denial.
More information on Utilization management timeframes can be found in the Capital Blue Cross Provider Manual – Chapter 5, Unit 1.