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Attention Members: If you are affected by Hurricane Dorian, get important information about your benefits/pharmacy.

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Prior Authorization & Claims

Find information about Healthy Blue services requiring prior authorization (PA), as well as important details about our claims process.

Access Availity

Find important self-service tools to review ongoing claims, or check the eligibility of members under your care.

Services Requiring Prior Authorization

Providers are responsible for verifying eligibility and benefits before providing services to Healthy Connections members. Failure to obtain prior authorization (PA) for services provided may result in a denial of the reimbursement request except in the case of emergency services.

To view the Medical Policies and Utilization Management Guidelines, visit www.HealthyBlueSC.com and select Providers.

Note: Referral to an out-of-network provider and/or facility requires PA for all services.

Requesting Prior Authorization

To request PA, report a medical admission or ask questions regarding PA, contact our Utilization Management (UM) department at:

  • Phone: 866-902-1689 
  • Fax: 800-823-5520
Prior Authorization Forms

General Prior Authorization Forms

Forms for Specific Procedures/Items

Contact the UM intake department for any questions on PA at 866-902-1689 or fax 800-823-5520.

* These links lead to a third-party site. That organization is solely responsible for the contents and privacy policies on its site.

Claims

Need information about our claims process? You'll find it here!