CommercialPrior AuthHigh impact
AB2026-01-002 Reminders
Capital Blue Cross·Provider News
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Effective January 1, 2026, Capital Blue Cross is transferring management of preauthorization for specialty injectable medications to Prime Therapeutics. Providers must now obtain preauthorizations for specialty injectables through Prime's portal at GatewayPa.com instead of the previous system.
Action Required
By January 1, 2026: All staff must transition to using Prime Therapeutics' GatewayPa.com portal for specialty injectable medication preauthorizations. Billing team must create accounts on GatewayPa.com portal and train providers on the new system. Update workflow procedures for POS 11 (physician office), POS 12 (patient home), and POS 19/22 (outpatient facilities). Review Capital Blue Cross Single Source Preauthorization List for affected medications. Failure to obtain preauthorization through the new system will result in claim denials.