Credentialing and Provider File Update Status Requests

High Dollar Claim Reviews

9/19/18

Beginning Oct. 1, 2018, BlueCross BlueShield South Carolina and BlueChoice HealthPlan will conduct some of the routine audit reviews on high-dollar claims on a pre-pay basis and itemized bills and medical records may be requested from your facility.

What this means for you:
Claims which require an itemized bill and/or medical records will reflect an adverse determination status on your remittance advice and notify you that documentation is needed. Claims which require additional information do not need to be appealed or have a request for reconsideration; they merely need the requested information submitted by the provider.  In most cases, the information can be uploaded through the claim attachments feature within My Insurance ManagerSM, our secure online provider portal. My Insurance Manager can be accessed from www.SouthCarolinaBlues.com or www.BlueChoiceSC.com. If you have questions on how to do this, please contact your education representative or send us an email to Provider.Education@bcbssc.com and a representative will be happy to walk you through the process.

What you need to do:
Monitor your remittance advices for requests for additional information and promptly send the information requested. Once the information has been submitted, the applicable claims will be reviewed. The preferred method for submitting requested information is through the online claim attachments feature within My Insurance Manager.   
 
If you have questions about this bulletin, please contact Provider Relations and Education by submitting the Provider Education Contact Form or by calling 803-264-4730 and a knowledgeable education specialist will respond.