Pre-payment High Dollar Claims Reviews Update

Pre-payment High Dollar Claims Reviews Update

Due to the current COVID-19 pandemic, Blue Cross Blue Shield of South Carolina and BlueChoice® HealthPlan will alter our audit processes on high dollar claims by completing them on a post payment basis instead of pre-payment.  We will resume the normal pre-payment reviews on high-dollar claims on June 1, 2020.

What this means for you:

Effective April 10, 2020, current claims over $200,000.00 will process with a post-payment review and high dollar claims received on or after June 1, 2020, will follow the normal pre-payment review process. All pre-payment and post-payment high dollar claims reviews will still require itemized bills and medical records may be needed as applicable.

What you need to do:

At this time, submit itemized bills, when requested 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 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.