CommercialReimbursementHigh impact
Notice to South Carolina Providers: Inpatient Readmission Payment Policy Update
BlueCross BlueShield of South Carolina·SC·Claims
Effective date
Aug 1, 2026
We identified it
Jul 15, 2026
Summary
Effective August 1, 2026, BlueCross BlueShield of South Carolina will deny separate reimbursement for inpatient readmissions occurring within 30 days of a prior admission when the readmission is for a clinically related, potentially preventable diagnosis. This applies to all acute care providers in South Carolina treating BCBSSC commercial members. Claims may be subject to medical review to determine clinical relatedness and preventability.
Action Required
By July 31, 2026: Billing team must implement a claims review process to identify inpatient readmissions within 30 days of prior admissions and flag them for medical review before submission to BCBSSC. Update billing system edits and claims scrubbing logic to capture readmission scenarios. Providers must document clinical justification for any readmissions claimed as non-preventable or clinically unrelated. Review the complete Inpatient Hospital Readmission Policy on My Insurance Manager for full criteria and exceptions (behavioral health, transplant, maternity/newborn, inter-facility transfers are exempt). Failure to follow this policy will result in claim denials for readmissions deemed preventable.