Modify or extend a preauthorization

Prior Authorization Modification and Date Extension Request

Required fields are noted with an asterisk *.

Member Information
Authorization Information
We will not be able to provide the change request because the claims has already been processed. If you have any questions, please contact the Capital BlueCross Preauthorization department at 800.471.2242.
We will not be able to provide the change request because the claims has already been processed. If you have any questions, please contact the Capital BlueCross Preauthorization department at 800.471.2242.
We will extend an authorization up to an additional two (2) weeks from your current end date.
Contact Information
Additional Information

If you are a Capital BlueCross participating provider, no return phone call will be made. Please verify in ProAuth within one business day to validate the end date has been extended. Out of area providers will receive a call back with in one business day of this request.

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