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Musculoskeletal and Joint Surgery Prior Authorizations Moving to Evolent

Sept. 9, 2026

BlueCross BlueShield of South Carolina is committed to keeping you informed of updates that may impact your administrative processes. Please review the following important information regarding an upcoming change to prior authorization (PA) management.

Effective Nov. 1, 2026, BlueCross will transition PA management for musculoskeletal and joint surgery procedures to Evolent® for the following plans:

  • Commercial, including BlueChoice® HealthPlan of South Carolina fully insured and ASO
  • All other BlueCross full insured business
  • Major Group and National Alliance ASO (for groups that elect the buy-up option)
  • Healthy Blue℠ (Medicaid)

The procedure codes managed are not new; however, all requests require submission of clinical documentation for review when a PA is requested.

How to Submit Prior Authorization Requests

Beginning Nov. 1, 2026, submit applicable PA requests via:

  • Evolent’s website: www.RadMD.com
  • Phone: 866-500-7664 (BlueCross members), 888-642-9181 (BlueChoice members) or 855-569-6749 (Healthy Blue members)

We appreciate your continued partnership and cooperation during this transition. Additional resources and guidance will be shared as the effective date approaches.

If you have questions, please contact your Provider Relations Consultant.

Evolent is an independent company that provides utilization management services on behalf of BlueCross BlueShield of South Carolina