Jan. 17, 2025

HealthHelp^® manages the prior authorization requirements for select procedures related to the following services:

• Musculoskeletal (procedures not currently reviewed by Evolent)
• Cardiology
• Surgical
• Sleep studies

This only applies to our Exchange (Affordable Care Act or Marketplace) plans with group numbers that start with 61, 62 or 65 except for our new Blue Direction plan (indicated by a ‘B’ in the fifth space of the group number).

The procedure codes managed by HealthHelp are not new. However, all codes require clinical documentation for review when a prior authorization is requested.
If the request does not meet clinical criteria, providers can expect a call from a physician at HealthHelp to request a peer-to-peer review.

Note: Any code not on the HealthHelp list is not managed by HealthHelp and should be directed to BlueCross BlueShield of South Carolina.

Prior authorization can be requested by:

• Online: My Insurance Manager℠
• Phone: 833-715-2255
• Fax: 844-470-2466

For questions regarding this bulletin, please contact your Provider Relations Consultant.

HealthHelp and Evolent are independent companies that provide utilization management services on behalf of BlueCross BlueShield of South Carolina.