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Provider Training and FAQs

Provider Training and FAQs

2019 Workshops
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Please join the BlueChoice® HealthPlan Provider Relations and Education team for our 2019 Annual Provider Summit. These free workshops are hosted annually to support and inform our providers on changes and new initiatives for the upcoming year.  

Join us on any of the dates below.

When you register, please let us know which Provider Relations Advocate invited you to attend. If you weren’t invited by an advocate, select Not Applicable.

Charleston, South Carolina
Tuesday, December 4, 2018

9 a.m. – 12 p.m. Registration at 8:30 a.m.

                OR

1 p.m. – 4 p.m.  Registration at 12:30 p.m.

Roper St. Francis Business Complex

8536 Palmetto Commerce Parkway

Ladson, SC 29456

 

Columbia, South Carolina

Wednesday, December 12, 2018 from 9 a.m. to 4 p.m.

                   OR

Thursday, December 13, 2018 from 9 a.m. to 4 p.m.

Registration at 8 a.m. Sessions begin at 9 a.m. each day.

Columbia Metropolitan Convention Center

1101 Lincoln St.

Columbia, SC 29201

 

Greenville, South Carolina

Monday, December 17, 2018

9 a.m. – 12 p.m. Registration at 8:30 a.m.

                    OR

1 p.m. – 4 p.m. Registration at 12:30 p.m. 

Greenville Health System Medical Staff Auditorium

701 Grove Rd.

Greenville, SC 29605

Benefit Update Meetings

2018 Benefit Update Meeting Presentation – A review of important benefit updates for 2018.
2017 Benefit Update Meeting Presentation – An overview of the 2017 benefit changes, procedures and new initiatives. 

Avalon Healthcare Solutions Benefits Management Program

Learn about our partnership with Avalon Healthcare Solutions for lab services. Avalon is an independent company that provides benefit management services on behalf of BlueChoice HealthPlan. Effective Jan.1, 2016, BlueChoice® will require Avalon Healthcare Solutions to precertify certain lab procedures when performed in an office, outpatient or independent lab location. 

Avalon Healthcare Solutions Claim Editor and Claim Trial Tool

This Avalon Laboratory Network Education presentation discusses the Claim Editor and how it provides consistent application of our medical policy to lab tests being performed to ensure that our members are receiving the highest quality of care at the most affordable cost. You'll also learn about the Trial Claim Tool. 

Avalon Healthcare Solutions Clinical Webinar

This clinical webinar is for laboratory ordering physicians, practice clinicians, and the like. Learn information about the scientific laboratory medical policy development and adherence through prior authorization and claim editor technology, resources available such as the policy education video library, Trial Claim Advice Tool and more.

BlueCard® Program

Learn about how the BlueCard program works, how to identify members and how to use the alpha prefix, as well as how to file claims. 

Credentialing Process

This presentation will give you an overview of the steps in the credentialing process to validate practitioners' qualifications. 

Durable Medical Equipment

Learn about durable medical equipment claims filing procedures, precertification requirements and using our Web tools, as well as information on CPAPs and more. 

Maternity Initiatives

Learn about our maternity initiatives programs. We adopted these programs and efforts in order to reduce health disparities among newborns and improve the overall health of mothers and babies. Learn the benefits of these programs and how to receive additional reimbursement.

Mental Health Webinar

Learn about Companion Benefit Alternatives (CBA). CBA is a separate company that administers mental health and substance abuse benefits on behalf of BlueChoice. Also learn about the health coaching process, the benefits of this program and important mental health plan tools.

Musculoskeletal (MSK) Care Management Program

The MSK presentation outlines prior authorization for two components of non-emergent MSK care: outpatient, interventional spine pain management services, and inpatient and outpatient lumbar and cervical spine surgeries. 

Quality Initiatives

Learn about our quality initiatives. Learn about programs to improve birth outcomes, techniques to closing gaps in care and benefits of becoming a patient-centered medical home. You will also get information about the importance of patient satisfaction and HEDIS quality measures.

South Carolina Reporting & Identification Tracking System (SCRIPTS)

Learn more about SCRIPTS, a database providers use to help monitor inappropriate use of prescription drugs, particularly opioids. Learn why SCRIPTS should be a part of every patient’s initial evaluation and subsequent monitoring, and is considered a standard of care. 

Specialty Drug Medical Benefit Management

Learn about the new specialty drug requirements for medical pharmacy benefits. This webinar provides an overview of the requirements as well as how to create a prior authorization through NovoLogix, CVS/caremark’s medical prior authorization system, with single sign-on access through My Insurance ManagerSM. CVS/specialty is a division of CVS Health, an independent company that provides pharmacy services on behalf of BlueChoice.

Web Tools Presentation 

Learn about the web tools available to help you get the information you need faster. 

Health Insurance Marketplaces Webinar 

Learn about our current plan offerings on the Federally Facilitated and private Exchanges.

Frequently Asked Questions (FAQs)

Here you can find some questions we've received from the provider community about these topics. If you have a question you would like to submit please contact us.