Pre-payment High Dollar Claims Reviews: New Dollar Threshold

Pre-payment High Dollar Claims Reviews: New Dollar Threshold

Effective Jan. 1, 2021, BlueCross® BlueShield® of South Carolina and BlueChoice HealthPlan will reduce the dollar amount of high dollar claims reviews from $200,000.00 to $100,000.00.

What this means for you:
Beginning Jan. 1, 2021, claims with the allowable charges of $100,000.00 or more will follow the normal pre-payment review process. All pre-payment high dollar claims reviews require itemized bills.

Note:  If needed, medical records will be requested.

What you need to do:
Submit itemized bills, when requested, via My Insurance Manager℠ (MIM) using the claims attachment feature. MIM can be accessed through www.BlueChoiceSC.com.

If medical records are needed, you will receive a separate request that will provide instructions on how to submit.

If you have any questions about this bulletin, contact Provider Education at using the Provider Education Contact Form.