CommercialPrior AuthHigh impact
Musculoskeletal and Joint Surgery Prior Authorizations Moving to Evolent
BlueCross BlueShield of South Carolina·SC · Orthopedics, General Surgery, Sports Medicine·Prior Authorization
Effective date
Nov 1, 2026
We identified it
Sep 18, 2026
Summary
Effective November 1, 2026, BlueCross BlueShield of South Carolina is transitioning prior authorization management for musculoskeletal and joint surgery procedures from internal processing to Evolent Health. All PA requests for affected plans (Commercial, BlueChoice, ASO, and Healthy Blue Medicaid) must now be submitted via Evolent's website or dedicated phone lines, and all requests require submission of clinical documentation for review.
Action Required
By October 31, 2026: Billing team must establish new prior authorization submission workflow for musculoskeletal and joint surgery procedures. (1) Update billing system to route all musculoskeletal and joint surgery PA requests to Evolent rather than BlueCross; (2) Create reference documentation with Evolent submission channels: website www.RadMD.com, phone 866-500-7664 (BlueCross commercial/ASO members), 888-642-9181 (BlueChoice members), or 855-569-6749 (Healthy Blue Medicaid members); (3) Revise PA submission templates and encounter forms to ensure clinical documentation is attached to all Evolent requests; (4) Train all billing, coding, and clinical staff on new submission process and contact information; (5) Update internal procedures manual and billing software workflow rules. Failure to submit through Evolent after November 1, 2026 will result in claim denials and processing delays. Contact BlueCross Provider Relations Consultant for additional resources as the transition date approaches.