Pre-payment High Dollar Claims Reviews Update

Pre-payment High Dollar Claims Reviews Update

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 July 1, 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 July 1, 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:

At this time, submit itemized bills and/or medical records when requested via secured fax to 803-264-8601. As this is a post-payment review, documentation cannot be uploaded online. This service is only available for unpaid claims. 
 
To see the original bulletin regarding the pre-payment review process for high dollar claims, click here.

If you have any questions, please contact Provider Education using the Provider Education Contact Form located on www.SouthCarolinaBlues.com or www.BlueChoiceSC.com.