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 20, 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 diagnosis and deemed potentially preventable. This policy applies to all South Carolina acute care providers and BCBSSC commercial members. Billing teams must implement medical review processes and update claim submission procedures to identify and handle affected readmissions.
Action Required
By July 31, 2026: Billing team must implement processes to identify inpatient readmissions occurring within 30 days of prior admission for clinically related diagnoses before claim submission. Update billing system or claim review workflow to flag potential readmissions for medical necessity review by BCBSSC. Coordinate with providers and care coordinators to document clinical justification for readmissions that may be deemed potentially preventable. Review the complete Inpatient Hospital Readmission Policy on My Insurance Manager for specific criteria and exceptions (behavioral health, transplants, maternity/newborn, facility transfers). Train billing staff to recognize exceptions and submit claims accordingly. Establish communication protocol with BCBSSC medical review team. Note: Healthy Blue implemented similar policy effective January 1, 2024—ensure alignment if dual payer. Failure to address readmission documentation will result in claim denials and revenue loss.