Precertification 

                                                                           Frequently Asked Questions

How can I complete a precertification request for two or more procedures via My Insurance Manager℠?

You cannot complete a precertification request for more than one service on a single entry using My Insurance Manager℠. Once you have chosen your request type and select one service, you will continue through the remaining precertification request screens to completion. At that time, you may begin a second request.

What is a dollar threshold for durable medical equipment (DME)?

Precertification requirements for DME can vary per plan. For this reason, it is important to verify eligibility and benefits.

How can I check authorization requirements for out-of-state members?

To check authorization requirements for out-of-state members, you can use the BlueCard® Prior Authorization Lookup Tool located on www.SouthCarolinaBlues.com or by calling the BlueCard eligibility line at 800-676-BLUE (2583).

What methods can be used to obtain precertification?

Authorizations can be requested using one of the following avenues: 

• My Insurance Manager*

• Medical Forms Resource Center (MFRC)*

• Fax

• Phone

*Preferred methods

What information is required when requesting precertification?

When requesting precertification, the following information should be included:

• Patient details – Name, ID number and date of birth

• Service details – CPT/HCPCs codes with correct units, diagnosis codes and MD orders

• Location details – Name of facility and rendering physician, address and Tax ID/NPI

• Contact details – Call back number and fax number

• Date of service

• Clinical documentation – Including how long the problem has been occurring, attempted treatments, conservative medications and studies (e.g., labs, imaging, assessments, etc.)