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 20, 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 with 61, 62, or 65 (excluding Blue Direction plans). All PA requests for these services must now be submitted to Evolent via online portal (www.RadMD.com) or phone (866-500-7664), and clinical documentation is now required for all PA requests in these categories.
Action Required
By June 30, 2026: Billing team must (1) identify all patients with BlueCross Exchange plans with group numbers beginning 61, 62, or 65 (excluding 'B' in fifth position); (2) update prior authorization workflow to route cardiology and joint surgery PA requests to Evolent instead of HealthHelp; (3) update billing system and encounter templates to require submission of clinical documentation with all PA requests for these service categories; (4) train billing staff and providers on new submission process using Evolent portal (www.RadMD.com) or phone line (866-500-7664); (5) update provider communications and internal workflows. Failure to route requests correctly and include clinical documentation may result in claim denials or delays in authorization.