ExchangePrior AuthMedium 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
Jun 20, 2026
Summary
BlueCross BlueShield of South Carolina is transitioning prior authorization management for cardiology and musculoskeletal/joint surgery procedures from HealthHelp to Evolent for Exchange (ACA marketplace) plans effective July 1, 2026. All PA requests for these services must now be submitted to Evolent via their online portal or phone system.
Action Required
By July 1, 2026: Billing team must update prior authorization workflow for Exchange plans with group numbers beginning with 61, 62, or 65 (excluding Blue Direction plans with 'B' in fifth position). Submit all cardiology and musculoskeletal/joint surgery PA requests to Evolent at www.RadMD.com or call 866-500-7664 instead of HealthHelp. Ensure clinical documentation is included with all PA requests as required.