Claims and Payment Resources

Filing claims electronically is fast, free and convenient. Here you will find out how to file claims online and set up your practice for electronic funds transfer payments.

 

Clinical Record Requirements

Find out what categories of claims generally require clinical documentation here.

Electronic Funds Transfer

BlueCross BlueShield of South Carolina and BlueChoice HealthPlan have been accepting enrollment for Electronic Funds Transfers (EFT) since August 1, 2002.

If you would like to participate in the EFT program, complete the following two forms and mail them to:

BlueCross BlueShield of South Carolina
Attn: EFT Coordinator (AF-326)
I-20 at Alpine Road Columbia, S.C. 29219

Electronic Funds Transfer Authorization Form

EFT Terms & Conditions

Electronic Media Claims (EMC) Filing

Do you have the capability to file your claims electronically? If the answer is yes, do you know the percentage of claims you file electronically to BlueChoice HealthPlan? We do!

It is our objective to have all hospitals and physicians file at least 90% of their claims to us electronically. Electronic Media Claims (EMC) filing is more efficient because it allows hospitals and physicians to receive payment 5-7 days faster than claims that are filed hardcopy. EMC filing also ensures claims accuracy through system edits. Therefore, EMC filing is our preferred method of receiving claims from our network facilities and practitioners.

Look for your rates below.

Hospital EMC rates:
Sorted by Rates

Sorted Alphabetically

Professional EMC rates (only for practitioners with greater than 90% EMC rates):
Sorted by Rates

Sorted Alphabetically

Updated 8/3/07

Electronic Remittance Advice

Continuing the theme of leveraging technology to eliminate paper and increase operational efficiency, we now allow health care providers to eliminate their paper remittance advices. In order to turn off paper remits, you must be set up for electronic funds transfer.

If you want to arrange for Electronic Remittance Advice (ERA), complete the following form and fax back to: 803-264-4790.

Request To Turn Off Paper Remits

To receive ERAs through our EDI Gateway (EDIG), please complete one of these forms: 

EDIG ERA Enrollment Form/Clearinghouse EDIG ERA Enrollment Form/Direct Submitter

 

Return the completed EDIG ERA Enrollment form to edi.services@bcbssc.com. The enrollment takes approximately one week.

My Remit Manager

Good news! For years, providers have asked us for the ability to build historical, member-specific remittances that would allow them to sort, view and print these remits through BlueChoiceSC.com. Now they can accomplish this using My Remit Manager! 

We are offering My Remit Manager FREE to all providers who want payment faster via electronic funds transfer (EFT) and who will allow us to eliminate paper remittance advices. Of course, we will continue to update the images of the paper remits currently available through My Insurance ManagerSM daily.

My Remit Manager accepts 835s from all commercial BlueChoice HealthPlan lines of business. It works independently of your practice management system or clearinghouse.

You will be able to:

View ERA information by file and see all details – Users have the option of viewing the specific ANSI details the payer sends or the standardized information in a conventional format. Instantly see patient errors and denials – My Remit Manager highlights any claims which have errors or have been denied.

 

Get started by visiting My Remit Manager and following the steps to register. We will e-mail you the information you need to get started.

  • View information categorized by check numbers or by patient – My Remit Manager clearly lists the name of each patient whose EOB is associated with an individual check or EFT.
  • Print individual remits for a single patient – Eliminate the need to remove or blackout other patient information on the remit.
  • Print remits for selected patients – Print individual or group remits.
Refund Process

Have you received an Overpayment Refund Request letter from us for a particular account? Have you received an overpayment on a claim you would like to voluntarily return to us? If so, please follow these guidelines to ensure smooth handling of your refund.

Unsolicited Refunds
Unsolicited refunds are those you voluntarily submit as the result of a possible claims overpayment or a payment made due to a billing and/or processing error.

Information needed: Please complete all the information on the Overpayment Refund Form.

Processing: We will review the information to determine the validity of the unsolicited refund request. We'll then determine if we will either adjust the claim to process the unsolicited request, or return the request and check with a written explanation of our findings.

Solicited Refunds
We request solicited refunds when we determine there is a claims overpayment or we made a payment in error.

Information needed: Please send the refund to us within the requested 30 days from the date of the letter. You must include a copy of the refund request letter for accurate and timely processing. Send your refund to:

BlueChoice HealthPlan
Attn: Lockbox, AX-430
4101 Percival Road
Columbia, SC 29223

Processing: It is critical that you return the refund within the specified timeframe. If we do not receive the refund within 30 days of the date of the refund request letter, we will systematically offset the amount on a future remittance. The systematic offset is the preferred method for many providers to reconcile refunds. This approach reduces the administrative costs associated with paper processing and minimizes the potential for duplicate refunds.

If you still need more information about a refund, please log in to My Insurance ManagerSM and submit your question using "Ask Provider Services."