Precertification

Need to request a precertification but don't know where to start? We've put together some information to better serve you when requesting  precertification. Our goal is to make the precertification process fast, easy and accurate.

Precertification Requirements

There are some services that routinely require precertification or admission certification for BlueCross BlueShield of South Carolina. Other services require precertification due to the member's contract benefits, type of service, etc. To determine if a service may require precertification, review our precertification requirements.

Please note:
While some groups require precertification for all of the services listed, others only require precertification for a portion of the outpatient services listed or none at all. Precertification requirements may vary from group to group or by health plan.

BlueCard® Precertification/Medical Policies

To access precertification/preauthorization and medical policy information for other Blue Plans, use the BlueCard Precertification tool. You will need the patient’s alpha prefix from his or her member ID card. Learn how you can initiate precertification for out-of-state members of other Blue Plans.

Radiology Precertification

BlueCross requires the State Health Plan and fully insured groups to get precertification for certain advanced imaging services through National Imaging Associates (NIA). NIA is an independent company that handles precertification for certain imaging services on behalf of BlueCross. Review the Radiology Precertification information to learn more.

Radiation Oncology Program

BlueCross requires NIA precertification for many radiation oncology services when you perform and bill them in an outpatient or office location. Review the Radiation Oncology Program information to learn more.

Submit a Precertification Online

Learn how to submit precertification requests online using My Insurance ManagerSM. You can submit requests for BlueCross and State Health Plan.

Submit Clinical Attachments Online

Learn how to submit clinical attachments for pending precertification requests online. You can submit requests for BlueCross and the State Health Plan. 

Documentation to Include for Precertification

Some services require addtitional documentation in order to review a precertification request. Find out what clinical information to submit for specific services and procedures.