Jan. 1, 2023

On Feb. 24, 2023, BlueCross BlueShield of South Carolina will partner with HealthHelp^® to manage the prior authorization requirements of selected procedures related to the below services for our Exchange (ACA) plans with group numbers starting with 61, 62 or 65.

• Musculoskeletal (procedures not currently reviewed by NIA Magellan_℠)
• Cardiology
• Surgical
• Sleep studies

Please be mindful that the list of procedure codes that will be managed by HealthHelp are not new. However, all codes will require clinical documentation for review when a prior authorization is requested.

If the request does not meet clinical criteria, providers can expect a call from a physician at HealthHelp to request a peer-to-peer review.

Note: Any code not on the HealthHelp list will not be managed by HealthHelp and should be directed to BlueCross.

Submitting prior authorization requests for codes managed by HealthHelp

HealthHelp prior authorizations can be requested:

• Online: My Insurance Manager℠
• Phone: 833-715-2255
• Fax: 844-470-2666

For questions regarding this bulletin, please contact the provider education team at 803-264-4730 or Provider.Education@bcbssc.com.

HealthHelp is an independent company that provides utilization management services on behalf of BlueCross BlueShield of South Carolina.

NIA Magellan is an independent company that provides utilization management services on behalf of BlueCross BlueShield of South Carolina.