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Prior Authorization Transition from HealthHelp to Evolent — Effective July 1, 2026
Act
by Jun 30, 2026
Effective date
Jul 1, 2026
Identified
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.
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What to do
by Jun 30, 2026 · 6 steps
01Billing 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.
02Update all internal documentation, provider communications, and encounter templates to reflect new submission channels: www.RadMD.com and 866-500-7664.
03Ensure staff are trained that clinical documentation must accompany all PA requests to Evolent.
04Update eligibility verification processes to identify affected plans at check-in.
05Verify that billing software can properly route requests by plan type and group number.
06Communicate new procedures to all clinical and administrative staff.
If missed: Failure to submit to correct vendor may result in claim denials or processing delays.
Original notice
Prior Authorization Transition from HealthHelp to Evolent — Effective July 1, 2026
southcarolinablues.com · Always check the source before changing claims.
Related changes
See all BlueCross BlueShield of South Carolina changes →Evolent Prior Authorization Management Expanding toInclude Interventional Cardiovascular and Physical Medicine Services — Effective Dec. 1, 2026HighEffective Dec 1, 2026 · Prior AuthorizationMusculoskeletal and Joint Surgery Prior Authorizations Moving to EvolentHighEffective Nov 1, 2026 · Prior AuthorizationPrior Authorization Transition from HealthHelp to Evolent — Effective July 1, 2026MediumEffective Jul 1, 2026 · Prior AuthorizationBrowse every BlueCross BlueShield of South Carolina change in the policy list