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)*
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.)