Modify or extend a preauthorization

Prior Authorization Modification and Date Extension Request

Required fields are noted with an asterisk *.

Member Information
Authorization Information
Extensions

We will not be able to provide the date extension. Please submit a new request.

We will extend an authorization up to an additional two (2) weeks from your current end date.
Modifications
Contact Information
Additional Information

If you are a Capital BlueCross participating provider, no return phone call will be made. Please check ProAuth within one business day to validate requested modification. 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