Boletín administrativo: 2026-09-002: solo Medicare

Date: September 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

Action required: Verify your provider information

  • CHIP
  • EPO
  • FEP PPO
  • HMO
  • Medicare Advantage HMO
  • POS
  • PPO
  • Tradicional e Integral
  • Medicare Advantage PPO

KEY POINT: As part of CMS interoperability requirements1, beginning in Plan Year 2027, Capital Blue Cross provider directory information will be displayed on Medicare.gov.

The Centers for Medicare & Medicaid Services (CMS) requires Medicare Advantage Organizations to maintain accurate provider directory information and update changes within 30 days of becoming aware of them, ensuring that Medicare beneficiaries can locate participating providers and make informed healthcare decisions.

In addition to Capital Blue Cross’s provider directory information, CMS routinely populates and validates provider directory data through NPPES records. To avoid conflicting information and ensure your information is displayed accurately to Medicare beneficiaries, please verify that your NPPES record contains the same information submitted to Capital Blue Cross.

What providers must do:

Providers are responsible for keeping their information current and accurate. Please review the information currently associated with your practice and promptly report any changes to Capital, including:

  • Nombre del proveedor
  • Practice location(s)
  • Phone number(s)
  • Specialty and subspecialty
  • Acceptance of new patients
  • Network participation status
  • Facility affiliation

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

1Medicare Advantage Par Providers: Per 42 CFR § 422.111(b)(3), the Centers for Medicare & Medicaid Services (CMS) require Medicare Advantage Organizations to have accurate provider directories, allowing Medicare beneficiaries the ability to identify and locate providers. Por lo tanto, los CMS recomiendan a todos los proveedores mantener sus datos de Identificador Nacional de Proveedores (NPI) actualizados en el Sistema Nacional de Enumeración de Planes y Proveedores (NPPES).