Prior Authorizations and Referrals

There are some services that require prior authorization or an admission notification. Review the lists of services that require prior authorization for BlueCross TotalSM and BlueCross SecureSM members.

Medicare Advantage Prior Authorization List for BlueCross Total PPO and BlueCross Secure HMO 

When You Should Prior Authorization

Prior authorization is a process used to determine if the services requested are medically appropriate. Prior authorization is also referred to as pre-service determination, authorization, precertification or precert. Verify whether a service requires prior authorization before rendering services. 

Services that require prior authorization and/or notification:

  • Durable medical equipment (DME)
    ‒      Non-standard wheelchairs 
    ‒      Non-standard beds
  •  All inpatient admissions
    ‒     
    All hospital inpatient admissions
    ‒      Rehabilitation facility admissions
    ‒      Long term acute care (LTAC)
    ‒      Skilled nursing facilities (SNF)
  • Dialysis treatment
    ‒      Notification is required for members initiating dialysis treatment
  • Non-emergent transportation
    ‒      Non-emergent air ambulance
    ‒      Non-emergent water transportation
  •  Behavioral health services
    ‒      Inpatient admissions
    ‒      Rehabilitation facility admissions
    ‒      Residential treatment centers

Behavioral health, mental health and substance abuse benefits are managed by Companion Benefit Alternatives (CBA), an independent company that manages these benefits on behalf of BlueCross BlueShield of South Carolina.

Inpatient admissions also require review if a continued stay is necessary.

Methods for Requesting Prior Authorization

You can request prior authorization for these services using any of these methods:

  • My Insurance Manager — The secure online provider portal available at www.SouthCarolinaBlues.com
  • Telephone — Call 1-855-843-2325
  • Fax — Fax requests to 803-264-6552

Companion Benefit Alternatives (CBA)