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South Carolina Healthy Connections

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September 2018 Medical Policies and Clinical Utilization Management Guidelines Update

November 27, 2018

The Medical Policies and Clinical Utilization Management (UM) Guidelines below were developed or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing prior authorization requirements have not changed.

Please share this notice with other members of your practice and office staff.

To search for specific policies or guidelines, visit and select Providers.

Medical Policies

On Sept. 13, 2018, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following Medical Policies applicable to Healthy Blue.

View the bulletin to see the full Medical Policies table.

Clinical UM Guidelines

On Sept. 13, 2018, the MPTAC approved the following Clinical UM Guidelines applicable to Healthy Blue. This list represents the guidelines adopted by the medical operations committee for the Government Business Division on September 27, 2018.

View the bulletin  to see the full Clinical UM Guidelines table.

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