Coming Soon! Magellan Healthcare and Musculoskeletal (MSK) Program Precertification

Coming Soon! Magellan Healthcare and Musculoskeletal (MSK) Program Precertification

2/16/2016

BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina have entered into an agreement with Magellan Healthcare to implement an MSK care management program. Magellan is an independent company that provides utilization management services on behalf of BlueCross and BlueChoice®.

BlueCross and BlueChoice plans not participating in the program include the Federal Employees Program (FEP), State Health Plan, self-funded plans and out-of-state members (BlueCard®).

We will require prior authorization for these non-emergent inpatient and outpatient spine surgeries:

  • Lumbar Microdiscectomy
  • Lumbar Decompression (Laminotomy, Laminectomy, Facetectomy & Foraminotomy)
  • Lumbar Spine Fusion (Arthrodesis)
  • Cervical Anterior Decompression with Fusion – Single and Multiple Levels
  • Cervical Posterior Decompression with Fusion – Single and Multiple Levels
  • Cervical Posterior Decompression (without Fusion)
  • Cervical Artificial Disc Replacement
  • Cervical Anterior Decompression (without Fusion)

We will require prior authorization for these non-emergent outpatient interventional spine pain management services:

  • Spinal Epidural Injections
  • Paravertebral Facet Joint Injections or Blocks
  • Paravertebral Facet Joint Denervation [Radiofrequency (RF) Neurolysis]

We issued formal announcement letters to providers this month that further describe key provisions to this program.

 

Read the full letter to learn more.

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.