Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company®, Capital Advantage Assurance Company® and Keystone Health Plan® Central. Independent licensees of the BlueCross BlueShield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies.
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We will not be able to provide the date extension. Please submit a new request.
Upon submission of the Prior Authorization Modification and Date Extension Request form, your request will be reviewed by a member of our Utilization Management team within one business day. All submissions will receive a return call—please ensure that an accurate and direct phone number is provided for the individual expecting the call.
The authorization is based on the member's benefits and eligibility as of today. Final determination of payment is based on the member's benefits, appropriateness of the service provided, and eligibility at the time the service is rendered and the claim is received.
Any questions, contact the Capital BlueCross Preauthorization department at 800.471.2242.
UM Department Capital BlueCross
PO Box 773731
Harrisburg, PA 17177-3731
