All PlansPrior AuthHigh impact
AB2026-04-003 Reminders
Capital Blue Cross·Provider News
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Capital Blue Cross issued multiple reminders including new preauthorization requirements for specialty injectable medications through Prime Therapeutics effective January 1, 2026, requirements to update provider data in CMS's National Plan and Provider Enumeration System, and expansion of shared administrative services with I.B. Abel Inc. through The Loomis Company.
Action Required
Immediately: 1) Billing team must obtain preauthorization for specialty injectable medications through www.GatewayPa.com for services in physician office (POS 11), patient home (POS 12), and outpatient facilities (POS 19, 22). Review Capital's Single source preauthorization list for all injectable medications. 2) Providers must update and certify NPI data in NPPES including provider name, addresses, phone/fax numbers, specialty, and practice locations. 3) For I.B. Abel Inc. members, use full member ID 'SASB XXXXXXXX' for claims and contact The Loomis Company at 800.432.8421 for preauthorizations. Claims without proper preauthorization will be denied.