New Update: Pre-payment High Dollar Claims Reviews

New Update: Pre-payment High Dollar Claims Reviews

Due to the COVID-19 pandemic, Blue Cross Blue Shield of South Carolina and BlueChoice® HealthPlan altered the audit process on high dollar claims by completing them on a post payment basis instead of pre-payment.  We had planned to resume the normal pre-payment reviews on high dollar claims on June 1, 2020, but this has been extended to September 30, 2020.
 
What this means for you:
As of April 10, 2020, current claims over $200,000.00 are being processed with a post-payment review.  High dollar claims received on or after September 30, 2020, will follow the normal pre-payment review process. All pre-payment and post-payment high dollar claims reviews require itemized bills and medical records may be needed as applicable.
 
What you need to do:
Currently, submit itemized bills upon request via secured fax to 803-264-8601.  If medical records are needed, you will receive a separate request that will include instructions on how to submit.
 

If you have any questions, please contact Provider Education using the Provider Education Contact Form.