CommercialReimbursementHigh impact
Notice to South Carolina Providers: Inpatient Readmission Payment Policy Updates
BlueCross BlueShield of South Carolina·SC·Claims
Effective date
Aug 1, 2026
We identified it
Aug 11, 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. Billing teams must implement medical review processes and documentation requirements to identify readmissions that qualify for this bundled payment policy. Certain admissions (behavioral health, transplants, maternity/newborn, and facility transfers) are exempt from this policy.
Action Required
By July 31, 2026: Billing team must implement the following: (1) Update billing system rules to flag inpatient claims submitted within 30 days of a prior inpatient admission for the same South Carolina BCBSSC member; (2) Establish a medical review process to identify clinically related diagnoses that may be deemed potentially preventable readmissions; (3) Communicate with clinical staff and providers to document clinical relationships between admissions and prevention efforts; (4) Configure billing system to bundle flagged readmission claims or hold them pending BCBSSC medical review determination rather than billing separately; (5) Train billing staff to recognize policy exceptions (behavioral health, transplants, maternity/newborn, facility transfers) and exempt those claims from the readmission review process; (6) Review the complete Inpatient Hospital Readmission Policy on My Insurance Manager for detailed criteria and documentation requirements. Providers should be notified of potential claim denials for readmissions that do not meet exception criteria. Failure to implement these controls will result in claim denials or recoupment of improperly paid readmission claims.