BCBS AFFILIATESCPBM: Companion Benefit Alternatives (CBA)

BlueCross BlueShield of South Carolina Prior Authorization Guide

Submit prior authorization requests and appeal denials with BCBS South Carolina. Phone numbers, fax numbers, appeal deadlines, step therapy override rights, and clinical documentation tips for SC providers.

Generate BCBS South Carolina LMN →

Prior Authorization Contacts

PA PHONE

1-800-334-7287

PA FAX

1-803-264-3040

TURNAROUND

30 days standard, 72h expedited

TIMELY FILING

180 days

APPEALS MAILING ADDRESS

BCBS of South Carolina, Attn: Grievance and Appeals, I-20 East at Alpine Road, AX-345, Columbia, SC 29219

Common Denial Reasons

⚠ Medical policy criteria not met
⚠ Step therapy — preferred agent not tried
⚠ Dose exceeds FDA label
⚠ Non-formulary without exception request

Step Therapy Requirements & Override Rights

BCBS of SC requires documentation of failed first-line therapy for most biologics (typically 3+ months of conventional DMARDs). South Carolina has a step therapy override law (Act 136 of 2019) requiring insurers to respond to override requests within 72 hours for non-urgent, 24 hours for urgent.

Tips for BCBS South Carolina Submissions

1. BCBS-SC uses its own internal PBM (Companion Benefit Alternatives), not Express Scripts
2. Reference BCBS-SC Medical Policy number in LMN
3. Submit via My Insurance Manager provider portal
4. SC step therapy override law (Act 136) entitles patients to exceptions

External Review Authority

If BCBS South Carolina denies your final internal appeal, you have the right to request an external review through: South Carolina Department of Insurance (within 120 days).

External review decisions are binding on the insurer.