News Bulletins
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2026 June Medical Policy Updates
August 27, 2026 Medical Policies -
Reminder: BlueExtend Plan
August 17, 2026 Benefits and EligibilityBlueExtend℠ is an ACA‑compliant plan offering coverage in select SC counties, using BlueEssentials in‑state and BlueCard PPO access when traveling.
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2026 May Medical Policy Updates
August 13, 2026 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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Reminder: High Dollar Pre-payment Review Process
August 13, 2026 ClaimsHigh Dollar Pre‑Payment Review ensures accurate payment of high‑cost claims, applying review thresholds of $100K or $75K to protect payment integrity.
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Updated Medicare Important Message (IM) and Detailed Notice of Discharge (DND) Forms
July 16, 2026 Medicare AdvantageCMS approved updated IM and DND forms with improved readability and design. Providers must transition to the new versions by May 15, 2026.
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Notice to South Carolina Providers: Inpatient Readmission Payment Policy Updates
July 10, 2026 ClaimsEffective Aug. 1, 2026, BCBSSC will no longer separately reimburse potentially preventable inpatient readmissions within 30 days for related diagnoses.
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Important Update – Prior Authorization for DME & Home Health Services
June 4, 2026 AuthorizationsEffective Aug. 1, 2026, DME and Home Health services for BCBSSC small group and individual plans (prefixes 61, 62, 64, 65) require IHCS prior authorization.
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Prior Authorization Transition from HealthHelp to Evolent — Effective July 1, 2026
May 12, 2026 AuthorizationsBlueCross will move prior authorization for some services to Evolent for certain Exchange plans on July 1, 2026. Check which plans and services are affected and how to submit requests.
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2026 April Medical Policy Updates
April 29, 2026 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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New Provider Coding Education Program, Provider Scope
April 3, 2026 ClaimsBlueCross BlueShield of South Carolina will partner with Codoxo’s Provider Scope® to review coding patterns and provide education without practice changes.
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2026 March Medical Policy Updates
April 3, 2026 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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Importance of Submitting Continued Stay Reviews in Cohere Health
March 25, 2026 AuthorizationsSubmit Continued Stay Reviews within seven days of the initial request to ensure uninterrupted care across inpatient, rehab, LTAC, and skilled nursing facilities.
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Updated MOON Notice and Requirement for Medicare Advantage
March 25, 2026 Medicare AdvantageCMS issued an updated Medicare Outpatient Observation Notice (MOON) on Feb. 24, 2026, impacting BlueCross BlueShield of South Carolina Medicare Advantage plans.
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Updates on Lupron Depot Injections for State Health Plan Members
March 11, 2026 Benefits and EligibilityAs of Jan. 1, 2026, Lupron Depot moved from pharmacy to medical benefit coverage for State Health Plan members and must be billed medically.
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New Phase Added to ClaimsXten
March 9, 2026 ClaimsClaimsXten™ (CXT) auditing expanded with a third phase effective March 2026, continuing to support accurate, compliant claims processing since 2019.
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Upcoming Post-payment Review Process Changes for Group and Individual Plans
March 9, 2026 ClaimsBlueCross BlueShield of South Carolina will use Cotiviti for post‑payment reviews of select hospital claims for group and individual plans.
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2026 February Medical Policy Updates
March 4, 2026 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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Update to Pharmacy Benefit Drug Prior Authorization Process for Exchange Members
February 5, 2026 Authorizations, PharmacyStarting April 1, 2026, BlueCross BlueShield of South Carolina will manage non‑specialty drug prior authorizations for Exchange members.
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2026 January Medical Policy Updates
February 3, 2026 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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New Year, Same 90-Day Validation Requirements
January 6, 2026 OtherProviders must verify or update demographic data every 90 days per CAA to remain in BlueCross BlueShield of SC directories and ensure accurate member access.
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2025 December Medical Policy Updates
December 29, 2025 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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High Dollar Pre-payment Review Update for Group and Individual Plans
December 11, 2025 ClaimsBeginning Jan. 1, 2026, HDPR applies to Group and Individual claims of $75,000 or more, ensuring accurate payment and protecting against fraud and waste.
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2025 November Medical Policy Updates
December 3, 2025 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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Introducing Coupe Health
December 2, 2025 OtherStarting Jan. 1, 2026, Coupe Health offers self‑insured employers a simpler, more predictable healthcare option with upfront costs and high‑quality provider guidance.
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Important Reminders for the E-sign Process for Provider Enrollment Applications
November 25, 2025 Provider EnrollmentAs of June 9, 2025, all provider enrollment applications, agreements, and related documents can be completed using electronic signatures.
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Important Updates for GLP-1 Provider Taxonomy Edits
November 14, 2025 PharmacyAs of Oct. 1, 2025, GLP‑1 prescriptions for Type 2 diabetes must be written by authorized providers with diabetes care expertise.
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Don't Forget Your 90-day Validations
November 14, 2025 Provider EnrollmentAccurate provider demographic data helps keep directories up to date, ensuring members can easily find the right physicians and facilities for care.
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2025 October Medical Policy Updates
October 31, 2025 Medical PoliciesOctober 2025 medical policy updates from BlueCross BlueShield of South Carolina, outlining new and revised policies, effective dates, and clinical guidance.
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2025 September Medical Policy Updates
September 26, 2025 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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2025 August Medical Policy Updates
August 28, 2025 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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The New E-signing Process for Provider Enrollment Documents
August 15, 2025 Provider EnrollmentBlueCross BlueShield of South Carolina launched My Provider Enrollment Portal 2.0 on June 9, 2025, adding e‑signatures and process improvements for easier enrollment.
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2025 July Medical Policy Updates
July 29, 2025 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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2025 June Medical Policy Updates
July 14, 2025 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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2025 May Medical Policy Updates
June 9, 2025 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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Reminder: GLP-1 Utilization Management
May 9, 2025 AuthorizationsUpdates to GLP‑1 medication management ensure safe, FDA‑approved use, reduce off‑label demand, and protect access for members managing serious conditions.
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2025 April Medical Policy Updates
April 25, 2025 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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2025 March Medical Policy Updates
March 31, 2025 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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2025 February Medical Policy Updates
February 27, 2025 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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Have You Checked our Medical Policies?
January 31, 2025 Medical PoliciesBlueCross BlueShield of South Carolina uses evidence‑based medical policies to determine medical necessity; coverage depends on the member’s benefit plan.
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2025 January Medical Policy Updates
January 30, 2025 Medical PoliciesBlueCross BlueShield of South Carolina and BlueChoice HealthPlan regularly update medical policies. Review the latest changes to stay informed on coverage decisions.
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Reminder: Importance of Correct Coding
January 27, 2025 ClaimsCorrect coding is essential for clean claims, ensuring accurate payment, fewer denials, and faster, more timely claims processing.
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