Blue Cross Blue Shield in Pennsylvania: Highmark, Capital and Independence
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Pennsylvania has three Blue companies, each with its own region, payer ID and rules. Highmark covers 42 Pennsylvania counties. Capital Blue Cross serves 21 counties in central Pennsylvania and the Lehigh Valley. Independence Blue Cross serves southeastern Pennsylvania. Check the member's ID card, then open the matching section.
Checked 10/1/26.
Highmark Blue Cross Blue Shield and Highmark Blue Shield
Across Highmark's states: Highmark Health is the parent company, and Highmark's entities are independent licensees of the Blue Cross Blue Shield Association (Highmark manual, chapter 1). Portal: Availity Essentials (support 800-282-4548). EDI help desk 800-992-0246, weekdays 8:00 a.m. to 4:30 p.m. Eastern. Paper claims must be on an original red CMS-1500. Credentialing: CAQH ProView first, then the Highmark Initial Credentialing Request Form (credentialing). Provider appeals: 180 days from the initial denial, by phone or in writing (chapter 5, unit 5). Timely filing, if your contract is silent: 365 days from the last date of service (PA CHIP: 180 days). Corrected claims: within 15 months of the original claim's finalization, effective 9/1/2026 (general claim guidelines). Behavioral health is in-house (Highmark Behavioral Health Services). As of March 1, 2026, outpatient prior authorization applies to ABA, intensive outpatient, partial hospitalization and TMS. The page does not list routine outpatient psychotherapy or medication management. FEP and Medicare are excluded (behavioral health unit). Telehealth: Reimbursement Policy RP-046 requires place of service 02 or 10 plus modifiers (telemedicine unit); read RP-046 for modifiers.
| Professional (837P) payer ID | 54771 (Medicare Advantage PPO: 15460) |
|---|---|
| Behavioral health phone | PA Western 800-258-9808; PA Central and Northeastern 800-628-0816. Fax 877-650-6112 |
| Provider appeals (professional, Central, Eastern and Northeastern regions) | Highmark Blue Shield, Attn: Appeals, PO Box 890035, Camp Hill, PA 17089-0035 |
| Provider appeals (Western region) | Pre-service: Highmark, 120 Fifth Ave, Suite P4301, Pittsburgh, PA 15222. Post-service: Highmark Medical Review, PO Box 890392, Camp Hill, PA 17089-0392 |
| Paper claims | The manual lists regional boxes. Use the box in the manual's "Claims Filing" section for your region |
| State regulator | Pennsylvania Insurance Department |
Source: Highmark manual, chapter 6, unit 2, matched to the March 2026 EDI companion guide.
Capital Blue Cross
Capital Blue Cross serves 21 counties in central Pennsylvania and the Lehigh Valley, and it is an independent licensee of the Blue Cross Blue Shield Association (provider hub).
| Blue company | Capital Blue Cross (also written Capital BlueCross) |
|---|---|
| Timely filing | Professional providers 180 days from the date of service. Facility 12 months. Medicare Advantage 365 days for all provider types (new provider welcome center) |
| Availity help | 800-282-4548 |
| Preauthorization and utilization management | 800-471-2242, weekdays 8:00 a.m. to 6:00 p.m. Mail: PO Box 773731, Harrisburg, PA 17177-3731 (preauthorization) |
| FEP | 800-344-5446 |
| Provider manual | Chapters on claims submission, behavioral health, credentialing and provider appeals sit behind the provider portal |
| State regulator | Pennsylvania Insurance Department |
Private payer: claims details. Capital's payer ID, paper claims address and appeal deadlines are in the portal manual. Ask your provider representative or read the 2026 manual after you log in.
Independence Blue Cross
Independence Blue Cross lists payer ID 54704 for Keystone Health Plan East, Personal Choice, BlueCard, Blue HPN and select Blue Cross Blue Shield IBX plans (IBX payer ID reference, April 2024). The same reference lists 54771 for Highmark, which is a different company. The reference is an April 2024 edition; check for a newer one.
| Blue company | Independence Blue Cross, southeastern Pennsylvania |
|---|---|
| Electronic payer ID | 54704 (alternates for Independence Administrators: TA720 or 54763) |
| Do not use for IBX | 54771 (Highmark Blue Cross Blue Shield and FEP Highmark) |
| Provider customer service | 1-800-ASK-BLUE (1-800-275-2583) |
| Credentialing | 215-988-1413, |
| Behavioral health authorization | 1-800-688-1911 |
| Behavioral health case management referrals | 1-844-505-2500 |
| Provider communications | provcomm.ibx.com |
| State regulator | Pennsylvania Insurance Department |
Private payer: behavioral health. Independence runs behavioral health utilization management in-house. It moved that work from Magellan Health Services, and its current behavioral health manual says IBX handles it, including ABA (IBX behavioral health manual). Under most IBX plans, preapproval is not required for routine and medication management outpatient behavioral health. Inpatient, residential, partial hospitalization, intensive outpatient, ABA and TMS need authorization.
Private payer: telehealth. IBX defines telehealth as behavioral health services by interactive telecommunications when the member and provider are in different places. Practitioners must be licensed in the state where the member is located.
Paper claims. The IBX General Information manual lists "Outer County: PO Box 211184, Eagan, MN 55121" for one group of members. Confirm the box for the member's county in the manual.
Frequently asked questions
Which Blue do I bill in Pennsylvania?
The one on the member's ID card: Highmark, Capital Blue Cross or Independence Blue Cross.
What is the Highmark Pennsylvania payer ID?
54771 for professional (837P) claims. Highmark's Medicare Advantage PPO uses 15460.
What is the Independence Blue Cross payer ID?
IBX lists 54704. The number 54771 belongs to Highmark, not Independence.
How MCM South helps with Blue Cross Pennsylvania
MCM South bills Blue plans for psychotherapists and psychiatrists in the states we serve. We verify benefits, submit claims electronically, follow up on denials and appeals, and handle credentialing. Get a free quote. If a Blue Cross Pennsylvania claim is denied or credentialing stalls, we follow up for you.
MCM South currently serves practices in GA, MA, CT, TX, FL, NY, CO, TN, NC and IL, and has worked in all 50 states. If your state is not on that list, ask us. This page is operational guidance for billing, not legal advice. For real financial or legal exposure, talk to your attorney or compliance officer.
Related: Blue Cross by State · How Blue Cross Blue Shield Works · Billing Terms Glossary · CPT and E/M Code Guide · Who We Serve.
This is the MCM South guide to Blue Cross Pennsylvania for therapists and psychiatrists: where claims go, how appeals work, and what to check first.
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