March 29, 2022

On June 1, 2022, BlueCross BlueShield of South Carolina’s Medicare Advantage line of business will begin requiring prior authorization for all admissions at the inpatient level of care. A request for inpatient level of care will be reviewed by our Utilization Management team, including licensed nurses and physicians, using the MCG CareWeb guidelines, 26th edition. MCG is an independent company that provides clinical guidance to BlueCross BlueShield of South Carolina.

Clinical documentation must be submitted with any inpatient request. This documentation must include physician’s notes, laboratory testing and other information that represents the severity of illness of the patient and the intensity of services being provided. If a request for an inpatient level of care does not meet the guidelines for approval, an outpatient observation level of care will be approved.

View more details on this upcoming change here.