Plan resources

Information for CHIP members, their parents and guardians.

Secure member account

View your benefits, claims, and balances online. Find doctors, hospitals, and treatment costs. View, print, or request ID cards. Get personalized health coaching and more. Log in to your secure account or register for access. Please note that email addresses for registration must be unique for each child.

Autopay

If your child is enrolled in one of the low- or full-cost programs, you may sign up for autopay. This program allows you to deduct your child's monthly premium payment from your checking account.

Visit the payment center to enroll in autopay.

Enrollment must be completed one business day prior to the scheduled withdrawal date.

*Service fees and limitations may be applicable under certain circumstances.

Privacy

Your child's privacy is important to us. Please read our notice of privacy practices and the GLBA notice. If you want us to talk with an individual not included on the CHIP application regarding your child's CHP coverage, complete the member authorization form.

Renewal

Your child's CHIP coverage must be renewed each year. If the renewal form is not received before the deadline, your child's coverage will expire. You'll receive renewal information 90 days prior to your child's anniversary date from the Department of Human Services (DHS). That renewal packet will provide instructions on how to complete the form and where to send it. If you have any questions regarding your renewal, call the Statewide Customer Service Center (CSC) at 1.877.395.8930.

You'll need to provide income verification documents for all income received in the household. You may also have to provide tax filing information to verify your tax filing status and/or any deductions you claim on your taxes. Additionally, if your child is not a U.S. citizen you may be required to provide verification of their immigration status.

If there are any special circumstances regarding your income, please explain in detail on a separate sheet of paper.

COMPASS walks you through the steps to complete a renewal, including what documentation is needed, including your acceptable proof of income and acceptable proof of citizenship and identity documentation. Once submitted, the renewal is sent to DHS immediately.

If you need assistance completing your renewal, call 800.543.7101 to request a COMPASS callback. A Capital Blue Cross Member Services Representative will help you schedule time with a CHIP Specialist to help you with completing your COMPASS renewal.

Rights and responsibilities

Acquainting yourself with your rights and responsibilities will help you take a more active role in your healthcare.

Other information

The CHIP newsletter has all the latest information, and if you have more CHIP questions, check out our FAQ page.

Network care providers

You must select a Primary Care Physician (PCP) for your child. Use our provider search to choose a PCP. You can also use this search to check if your child’s current physician is a KHPC participating PCP and you can include the name of the selected PCP on the application.

Additional resources

Accessing personal health information and provider information through a third-party health app

Our CHIP members can view their Capital Blue Cross health information through a third-party application, or “health app.” Health apps can have different names and are owned by companies other than us. They can be downloaded from an app store to your smart phone, tablet, or computer. Health apps may help you access your health information. Not all health-related apps have this feature.

We make your information available to a health app only if you allow us to share the information. Read more.

Prior Authorization metrics for medical items and services (excluding drugs)

To comply with the CMS Interoperability and Prior Authorization final rule, Capital Blue Cross is required to annually report aggregated prior authorization metrics on our website. Specifically, this includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (e.g., approvals, denials, etc.) over the previous calendar year. Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers.

For questions on the data below, contact us.

Reporting period: 2025

For medical items and services for which we require prior authorization (excluding drugs), refer to our single source preauthorization list.

Beginning January 1, 2026, the CMS Interoperability and Prior Authorization final rule updated certain timeframes for sending prior authorization decisions; however, CHIP managed care organizations must continue to follow Pennsylvania Act 146. Decision timeframes remain:

  • Two business days for requests, if all information has been provided.

Decision

How many times this happened

Out of total requests

Percentage

Request approved

40,000

50,000

80%

Request denied

10,000

50,000

20%

Decision

How many times this happened

Out of total requests

Percentage

(optional) Request approved with 7 days

29,500

50,000

59%

(optional) Request denied within 7 days

5,500

50,000

11%

Decision

How many times this happened

Out of total requests

Percentage

Request approved only after time for review was extended*

7,500

50,000

15%

(optional) Request denied after time for review was extended

2,500

50,000

5%

Decision

How many times this happened

Out of total requests

Percentage

Request approved only after appeal

3,000

5,000

60%

(optional) Request denied after appeal

2,000

5,000

40%
Expedited (urgent) Prior Authorization Requests (Response Due to Provider Within 72 Hours)

Decision

How many times this happened

Out of total requests

Percentage

Request approved

test

test

test

Request denied

test

test

test

Decision

How many times this happened

Out of total requests

Percentage

(optional) Request approved with 72 hours

test

test

test

(optional) Request denied within 72 hours

test

test

test

Decision

How many times this happened

Out of total requests

Percentage

Request approved only after time for review was extended*

test

test

test

(optional) Request denied after time for review was extended

test

test

test

*As noted on the first page of this template, it is optional to report this metric separately for standard prior authorizations and expedited prior authorizations.

Decision

How many times this happened

Out of total requests

Percentage

(optional) Request approved only after appeal

test

test

test

(optional) Request denied after appeal

test

test

test
Time Between Receiving a Prior Authorization Request and Sending a Decision

Decision

Mean (Average) Time

Median (Middle) Time

Standard (non-urgent) Prior Authorization Requests (response due to provider within 7 calendar days)

5 days

4 days

Expedited (urgent) Prior Authorization Requests (response due to provider within 72 hours)

1 day

1 day

CHIP coverage is issued by Keystone Health Plan® Central through a contract with the Commonwealth of Pennsylvania. Capital Blue Cross Dental and Capital Blue Cross Vision are issued by Capital Advantage Assurance Company®. Capital Advantage Assurance Company and Keystone Health Plan Central are subsidiaries of Capital Blue Cross. All are independent licensees of the Blue Cross Blue Shield Association. Communications are issued by Capital Blue Cross in its capacity as administrator of programs and provider relations.

Frequently asked questions

If you have a question about  CHIP coverage, please visit our frequently asked questions page.