Reminder: Reverting to Pre-payment High Dollar Claims Review

Reminder: Reverting to Pre-payment High Dollar Claims Review

Due to the COVID-19 pandemic, BlueCross® BlueShield® of South Carolina and BlueChoice HealthPlan altered the auditing process of high dollar claims by completing them on a post-payment basis, which was extended to Sept. 30, 2020.  For more details, click here.

On Nov. 1, 2020, both plans will revert to processing high dollar claims in the amount of $200,000.00 or more on a pre-payment review basis.  Be mindful that beginning Jan. 1, 2021, the dollar amount will be reduced to $100,000.00.  For more information on this change, click here.

All high dollar pre-payment claims reviews require itemized bills.  Submit itemized bills, when requested, via My Insurance Manager℠ (MIM) using the claims attachment feature.  MIM can be accessed through www.SouthCarolinaBlues.com or www.BlueChoiceSC.com.

Note: If medical records are needed, you will receive a separate request that will provide instructions on how to submit.

For questions about this bulletin, contact Provider Education at Provider.Education@bcbssc.com