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Prior Authorization Management for Medical Specialty Drugs Is Changing
Effective date
Dec 1, 2026
Identified
Sep 24, 2026
Summary
Effective Dec. 1, 2026, BlueCross BlueShield of South Carolina is transitioning prior authorization management for medical specialty drugs from MBMNow to internal resources for Marketplace (ACA) plans with group prefixes 23, 27, 61, 62, 63, 65, and 68. Providers must submit medical specialty drug prior authorization requests through Cohere Health via My Insurance Manager instead of MBMNow, though clinical documentation requirements remain unchanged.
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What to do
Action · 3 steps
01By Nov.
0230, 2026: Billing and prior authorization teams must (1) update all internal processes and staff training to direct medical specialty drug prior authorization submissions to Cohere Health via My Insurance Manager instead of MBMNow for affected BlueCross/BlueChoice Marketplace plans with group prefixes 23, 27, 61, 62, 63, 65, and 68; (2) verify system access and login credentials for Cohere Health; (3) update claim submission workflows and provider communication templates to reflect the new submission portal; (4) document the transition timeline in practice procedures.
03Contact your BlueCross Provider Relations Consultant with questions.
If missed: Failure to submit through the correct portal after the effective date may delay authorization decisions and claim processing.
Original notice
Prior Authorization Management for Medical Specialty Drugs Is Changing
southcarolinablues.com · Always check the source before changing claims.