Avoid costs by getting the green light for your care. Some medical and behavioral health services need prior authorization for the State Health Plan to provide coverage. This means you or your provider needs to make a phone call. Not calling for  prior authorization may lead to a $515 penalty. Prior authorization does not guarantee payment. More information about prior authorization is available in the Insurance Benefits Guide.

Medical Services

To request prior authorization for your medical treatment, call Medi-Call at 800.925.9724 at least two business days before:

• Inpatient care in a hospital, including admission to a hospital to have a baby.
• An outpatient service that results in a hospital admission.
• Outpatient surgery for a septoplasty (surgery on the septum of the nose).
• Outpatient or inpatient surgery for a hysterectomy.
• Sclerotherapy (vein surgery).
• Chemotherapy or radiation therapy.
• Admission to a long-term care facility or nursing facility.
• Ordering durable medical equipment.
• In vitro fertilization or other infertility procedures.
• An organ transplant.
• Inpatient rehabilitation services and related outpatient physical, speech or occupational therapy.

Pregnancy

You should contact Medi-Call at 800.925.9724 within the first three months of a pregnancy.

Emergencies

In a hospital emergency, you should contact Medi-Call at 800.925.9724 to report your admission within 48 hours or the next business day.

Radiology Services

To request prior authorization for your radiology services, call National Imaging Associates at 866.500.7664.

• CT scan.
• MRI.
• MRA.
• PET scan.

Behavioral Health Services

To request prior authorization for your behavioral services, call Companion Benefit Alternatives at 800.868.1032.

• Inpatient hospital care.
• Intensive outpatient hospital care.
• Partial hospitalization care.
• Outpatient electroconvulsive therapy.
• Repetitive transcranial magnetic therapy.
• Applied behavioral analysis therapy.
• Psychological/neuropsychological testing.

Some outpatient behavioral health services may not be covered by the Plan if the service is not approved through prior authorization.

Specialty Medication

Specialty medications are prescription drugs that are used to treat complex or chronic medical conditions. Specialty medications may be physician-administered or self-injected. For a list of medications that require prior authorizations, click here.

For most specialty medications, your doctor must request prior authorization. Doctors can request prior authorization by signing in to My Insurance Manager^®, calling 877.440.0089 or faxing 612.367.0742.

A typical prior authorization is valid for up to one year. This may vary based on the medication and its dosing schedule. Your doctor will receive an expiration notification by mail or fax at least 60 days before the prior authorization expires.

National Imaging Associates (NAI) is an independent company that handles precertification for certain imaging services on behalf of BlueCross BlueShield of South Carolina.

Companion Benefit Alternatives Inc. (CBA) is a separate company that assists in management of behavioral health and substance abuse benefits on behalf of BlueCross BlueShield of South Carolina.