Provider update on Change Healthcare

Capital Blue Cross has been closely monitoring the cyber incident affecting Change Healthcare, one of the nation's major processors of prescription drug claims and electronic claim processing. The incident is preventing some providers and pharmacies who use Change Healthcare to verify insurance coverage, benefits, enrollment, and may cause some delays in processing prescriptions and claims transmissions.

Please note the cyber incident is not directly affecting Capital’s own provider tools or resources, which remain secure and available for use.

To ensure providers and members have minimal disruptions at this time, we are providing the following guidance until the situation affecting Change Healthcare is resolved.

Benefits, claims and prior authorization

As noted, Capital's provider assistance resources remain in operation. Providers who use systems other than Change Healthcare can continue to follow their current processes for verifying benefits or eligibility, submitting claims, or seeking prior authorization.

Those who use Change Healthcare can instead interact directly with Capital regarding prior authorization, benefits, and claims by:

Accessing the Availity Essentials portal
Emailing us at providerbenefitcorrespondence@capbluecross.com
Calling us at 1.866.688.2242

Filling Prescriptions

Our first priority is ensuring our members receive the care and medications they need.

Given the Change Healthcare issue is not impacting all pharmacies, we are advising members first try to fill their prescriptions as they normally would. Capital’s pharmacy benefit manager, Prime Therapeutics, has informed Capital that most major pharmacy chains, including CVS, RiteAid, Wal-Mart, Target, Walgreens, Costco, Giant, and Weis Markets are currently processing claims without interruption.

If a member’s current pharmacy is unable to process a prescription, options include:

Paying for the prescription out-of-pocket and receiving reimbursement by submitting the receipt with a claim form.
Having the prescription filled by a pharmacy not impacted by Change Healthcare’s outage.
Contacting us directly using the number on the back of their Capital ID card for support and assistance.

Thank you for working with us to ensure Capital Blue Cross members continue to receive the best care possible.

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