SHOP PLANS MEMBERS PROVIDERS EMPLOYERS AGENTS Providers Providers Search Home Providers Policies and Authorizations Prior Authorization Show Related Pages Prior Authorization Always check benefits through the Voice Response Unit (VRU) or My Insurance ManagerSM to determine if prior authorization is required. Many of our plans require prior authorization for certain procedures and durable medical equipment. This process allows us to check ahead of time whether services meet criteria for coverage by a member’s health plan. In many cases, approval is instant. When it’s not, we’ll review your request, taking into account: Our medical policies Recognized clinical guidelines Out-of-area patients (BlueCard®) The terms of the member’s benefit plan Some requests may require additional documentation. Requesting Prior Authorization When you request prior authorization from us, we want the process to be fast, easy and accurate. We offer these convenient options: Medical Forms Resource Center (MFRC) – This online tool makes it easy to submit prior authorization requests for certain services. The tool guides you through all of the forms you need so you can avoid follow-up calls for additional information. When you use MFRC, your requests get priority processing. My Insurance Manager – You also can submit prior authorization using the same online self-service provider tool you can use to check eligibility, manage claims and more. Fax – If you would prefer to submit your request by fax, complete and follow the submission directions on this form: Precertification Request Form Mental Health Prior Authorization A few plans may continue to require prior authorization for mental health services. Contact Companion Benefits Alternatives (CBA) to verify by calling 800-868-1032. CBA is a separate company that administers mental health and substance abuse benefits on behalf of BlueCross BlueShield of South Carolina and BlueChoice HealthPlan. BlueChoice® HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association. Special Programs These services require prior authorization through third party vendors. Laboratory Medical Benefits Musculoskeletal Care Nonspecialty Medications Radiation Oncology Radiology Specialty Medical Medications Medicare Advantage Prior Authorization These resources are available for prior authorization through BlueCross. BlueCard Prior Authorization/Medical Policies Medical Forms Resource Center My Insurance Manager Prior Authorization Frequently Asked Questions FOR Shop Plans Members Providers Employers Agents ORGANIZATION About Us Careers Newsroom Blog Privacy & Legal Interoperability Rate Justification URAC Accreditation ASSISTANCE Contact Us Find an Agent Technical Support Become a Supplier Accessibility Report Fraud Facebook Twitter LinkedIn Youtube Live Life Blue Instagram RSS Non-Discrimination Statement and Foreign Language Access Copyright © 2021 All rights reserved. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association.