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Evolent Prior Authorization Management Expanding toInclude Interventional Cardiovascular and Physical Medicine Services — Effective Dec. 1, 2026
Act
by Nov 30, 2026
Effective date
Dec 1, 2026
Identified
Sep 29, 2026
Summary
Effective December 1, 2026, Evolent will assume prior authorization management for select interventional cardiovascular services (cardiac catheterization, interventional cardiology, electrophysiology, vascular/endovascular interventions, cardiac surgery, vascular surgery) and physical medicine services for Healthy Blue members. All PA requests for these services must be submitted to Evolent through new contact channels beginning on this date.
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What to do
by Nov 30, 2026 · 4 steps
01Billing and clinical staff must update internal workflows and billing system rules to route all prior authorization requests for cardiac catheterization, interventional cardiology, cardiac electrophysiology, vascular/endovascular interventions, cardiac surgery, vascular surgery, and physical medicine (for Healthy Blue only) to Evolent instead of BlueCross BlueShield.
02Update staff contact lists and provider communication materials with Evolent's three phone numbers (866-500-7664 for BCBS Commercial/Exchange; 888-642-4810 for BCBS Publix; 855-569-6749 for Healthy Blue; 888-642-9181 for BlueChoice Commercial/Exchange) and online submission portal (www.RadMD.com).
03Billing team must attend Evolent provider training webinars at go.evolent.com/bcbssc-program-changes-december-1-2026 to understand new submission processes and requirements.
04Update encounter forms, care coordination protocols, and billing software to reflect Evolent as the PA authorizer for these service categories.
If missed: Failure to submit to Evolent after December 1, 2026 will result in claim denials for affected procedures.
Original notice
Evolent Prior Authorization Management Expanding toInclude Interventional Cardiovascular and Physical Medicine Services — Effective Dec. 1, 2026
southcarolinablues.com · Always check the source before changing claims.