Capital Blue Cross

Welcome to the Capital Blue Cross page.  The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent is responsible for managing. Additional process-specific training tools and modules can be found via links on the Resources tab at the top of the screen.

If you have any questions about our programs, please contact your dedicated Evolent Provider Engagement Manager:

• Andrew Dietz (Advanced Imaging/Cardiology)
• Janet Nunez (Oncology)

Program Updates: 

• Effective June 5, 2026, Capital Blue Cross Commercial and Medicare members: For the first 90 days after a member’s enrollment, an active course of treatment that began before the member joined Capital Blue Cross may be eligible for continuity of care. For services that are part of an active, previously established plan of care (for example, post-operative therapy or other ongoing treatment that started under the prior plan), please call the call center at 1.888.203.1423 and indicate that you are requesting continuity of care for a new enrollee. Our team will determine whether the service qualifies for continuity of care and, when it does, will process the authorization consistent with Medicare Advantage continuity of care requirements.  
• Effective June 1, 2026, select Advanced Imaging services for Capital Blue Cross Medicare no longer require prior authorization. Please refer to the updated Advanced Imaging Utilization Matrix.

Peer-to-Peer Process  

For access to our peer-to-peer process, click here.

Conservative Treatment Forms  

For access to our conservative treatment forms, click here.