Provider Resources
The Centers for Medicare and Medicaid Services (CMS) require First Tier, Downstream, and Related Entities (FDRs) attest annually that they have completed specific compliance and fraud, waste, and abuse (FWA) requirements. Health care providers are FDRs and are required to comply with these compliance requirements.
You’ve got a lot going on. Keep us in the loop with changes.
Provider organizational (acquisitions, mergers, etc.) changes
Capital Blue Cross contracted providers should communicate organizational (acquisitions, mergers, etc.) changes to Capital via notifications@capbluecross.com. Note: This email is not to be used for provider demographic changes.
Resources to make your transfers go even more smoothly.
Cut down on admin costs with secure electronic payments.
Meet our partners in health.
Stay up to date with the provider portal.
Support for your patients’ chronic conditions.
Utilization management
Our utilization management staff is available Monday through Friday from 8:00 AM - 6:00 PM. If you leave a message outside of those hours, we'll return your call the next business day. Visit our medical policies for decision information. Visit preauthorization for member information. Or, call us about InterQual criteria documentation.
Contact utilization management at 800.471.2242.
As of January 1, 2025, Carelon Behavioral Health will no longer be Capital Blue Cross’ behavioral health manager for mental health and substance use disorder services. Moving forward, Capital Blue Cross will offer services to support mental health and substance use. Services include preauthorization, discharge planning and after-care monitoring for Capital Blue Cross members.
Beginning January 1, 2025, you can initiate a preauthorization request by accessing the Preauthorization application via Our Provider Portal. Here you will be able to perform a preauthorization inquiry, request preauthorization for Inpatient and Outpatient services, request a preauthorization for a Member to see a non-Participating Provider and perform a pre-service review for out-of-area Members.
