ExchangePrior AuthHigh impact
Prior Authorization Transition from HealthHelp to Evolent — Effective July 1, 2026
BlueCross BlueShield of South Carolina·SC · Cardiology, Orthopedics·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Aug 11, 2026
Summary
Effective July 1, 2026, BlueCross BlueShield of South Carolina is transitioning prior authorization management for select cardiology and musculoskeletal (joint surgery) procedures from HealthHelp to Evolent for Exchange (ACA) plans with group numbers beginning 61, 62, or 65 (excluding Blue Direction plans). All PA requests for these services must now be submitted to Evolent via www.RadMD.com or phone 866-500-7664, and clinical documentation is required for all submissions.
Action Required
By June 30, 2026: Billing team must update prior authorization workflows and system configurations to route cardiology and musculoskeletal/joint surgery PA requests for affected Exchange plans (group numbers 61, 62, 65 excluding Blue Direction) to Evolent instead of HealthHelp. Update all internal documentation, provider communications, and encounter templates to reflect new submission channels: www.RadMD.com and 866-500-7664. Ensure staff are trained that clinical documentation must accompany all PA requests to Evolent. Update eligibility verification processes to identify affected plans at check-in. Verify that billing software can properly route requests by plan type and group number. Communicate new procedures to all clinical and administrative staff. Failure to submit to correct vendor may result in claim denials or processing delays.