BlueCross BlueShield of South Carolina
Welcome to the BlueCross BlueShield of South Carolina Health Plan page. Here you can download policies and procedures specific to both ordering and rendering providers. These include quick reference guides and information designed to assist you in using RadMD to request and check the status of prior authorizations.
If you have any questions about our programs, please contact your dedicated NIA Provider Relations Manager, Priscilla Singleton.
Advanced Imaging Program
- Utilization Review Matrix-2022 - effective 10/1/2022
- Utilization Review Matrix-2022 for University of Vermont Members ONLY - effective 8/1/2022
- Quick Reference Guide
- Frequently Asked Questions
- Denial Notification
- Peer-to-Peer Process
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD Documents
RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by program:
Spine Care Program
Effective May 1, 2016, BlueCross and BlueChoice will implement a musculoskeletal program. This program includes prior authorization for two components of non-emergent musculoskeletal care: outpatient, interventional spine pain management services; and inpatient and outpatient lumbar and cervical spine surgeries.
The Call Center will be available beginning Monday, April 25, 2016, for prior authorization for dates of service May 1, 2016, and beyond.
- Frequently Asked Questions- Interventional Pain Management
- Frequently Asked Questions-Lumbar and Cervical Surgeries
- MSK- Provider Training
- MSK-Quick Reference Guide
- BCBSSC and BlueChoice IPM Utilization Matrix-2022
- BCBSSC and Blue Choice Spine Surgery Utilization Matrix-2022
- Interventional Pain Management Checklist
- Spine Surgery Checklist
Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
Radiation Oncology
Effective January 1, 2015, BlueCross BlueShield of South Carolina and BlueChoice HealthPlan/NIA Magellan will provide utilization management services for all outpatient radiation therapy for all cancer sites effective January 1, 2015.
Radiation Oncology Checklists
- Anal Cancer
- Bone Metastatic Cancer
- Bone Primary Cancer
- Breast Cancer
- Central Nervous System (CNS) Metastatic Cancer (Brain/Spine)
- Central Nervous System (CNS) Primary Cancer (Brain/Spine)
- Cervical Cancer
- Colon
- Endometrial Cancer
- Gastric Cancer
- Head and Neck Cancer
- Hodgkins Lymphoma
- Lung Cancer (Non-Small Cell)
- Lung Cancer (Small Cell)
- Non-Hodgkins Lymphoma
- Pancreas Cancer
- Prophylactic Cranial Irradiation
- Prostate Cancer
- Rectal
- Skin Cancer
- Other Cancer
- Other Metastatic Cancer
NIA Radiation Oncology Coding Standards - Effective 1/1/2022
Radiation Oncology Management Educational Documents
- Radiation Oncology Utilization Review Matrix-2022
- Radiation Therapy Treatment Notification Form for Transition Cases
- Radiation Oncology Solutions Program
- Frequently Asked Questions For Radiation Oncologists and Cancer Treatment Facilities
- Radiation Oncologists and Cancer Treatment Facilities Quick Reference Guide
Clinical Guidelines
- Clinical Guidelines
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Refer to the Utilization Review Matrix document to view specific codes managed by NIA
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.
Update on COVID-19
Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).