Always check benefits through the Voice Response Unit (VRU) or My Insurance Manager^SM to determine if prior authorization is required.

Prior authorization is a process used to determine if a requested service is medically necessary. Currently, Medicare Advantage requires prior authorization for these services.

Note: These requirements only apply to South Carolina members. For members who have other Blue^® plans, please contact their home plan to verify the authorization requirements.

Services Requiring Universal Prior Authorization

• All inpatient admissions — Inpatient admissions also require review if a continued stay is necessary.
  • Hospital inpatient
  • Rehabilitation facilities
  • Long term acute care
  • Skilled nursing facilities
• Inpatient level of care for nonemergency surgery
• Behavioral health services

Note: Behavioral health services are managed by Companion Benefit Alternatives (CBA), a separate company that offers behavioral health benefits on behalf of BlueCross BlueShield of South Carolina.

Codes That Require Prior Authorization

View the complete list of codes requiring prior authorization.

Medical Policies

You can review Medicare Advantage's medical policies for all the previously-mentioned services for more information.

Methods for Requesting Prior Authorization

Medical services

• My Insurance Manager
• Phone: 855-843-2325
• Fax: 803-264-6552

Behavioral health services

• Online: www.CompanionBenefitAlternatives.com
• Phone: 833-971-4075

Laboratory services

• PAS Portal — This is Avalon's prior authorization system (PAS). If you do not have an account, request one here.
• Phone: 844-227-5769
• Fax: 813-751-3760 — Submit the Preauthorization Request Form along with supporting documentation.

DME (in the home setting), home health and home infusion services

• Phone: 844-215-4264
• Fax: 844-215-4265

Avalon’s Laboratory Network

Avalon also manages a network of labs. Our members pay less out of pocket when you use network labs rather than non-network labs. We urge you to use participating laboratories, when possible. 

Interested in enrolling in our lab network? Go to the Avalon website to get started.