Frequently Asked Questions
Can BlueChoice HealthPlan of South Carolina pay ancillary claims and withhold payment from the surgeon who has the medical records when medical records are requested?
BlueChoice HealthPlan of South Carolina cannot withhold payment from the surgeon who has the medical records because these are not global charges. However, please return the medical records requested to us with the referring/rendering providers’ names included. We need the medical records to reimburse any professional provider in this situation.
Where should durable medical equipment (DME) claims be submitted?
DME claims should be filed to the Plan whose state the equipment was purchased at a retail store, or to the Plan whose state the equipment was shipped.
Where should laboratory claims be submitted?
Laboratory claims should be filed to the Plan where the specimen was drawn, or to the Plan where the referring physician is located.
Should members be notified you will bill them if they visit an out-of-network lab?
Yes, we require you to inform members we may bill them for for use of a non-participating lab.
Where should specialty pharmacy claims be submitted?
Specialty pharmacy claims should be filed to the plan where the ordering or referring physician is located.