Financial

We want to make your interactions with BlueCross BlueShield of South Carolina as easy and efficient as possible. Use these forms to save time and costs for your practice.

• Electronic Funds Transfer (EFT) and Electronic Remit Advice (ERA) Enrollment Form and EFT Terms and Conditions – Use this form if you want to participate in the EFT program and do not currently receive an ERA. The authorized person who signs this form must sign the EFT Terms and Conditions. You can fax completed forms to 803-870-8065, Attn: EFT Coordinator, or email to provider.eft@bcbssc.com.
• EDIG ERA Enrollment Form/Clearinghouse and EDIG ERA Enrollment Form/Direct Submitter – To receive ERAs through our EDI Gateway (EDIG), please complete one of these forms. Return the completed EDIG ERA Enrollment form to edi.services@bcbssc.com. The enrollment takes approximately one week.  
• Overpayment Refund Form – Use this form when sending BlueCross unsolicited/voluntary refund checks. 

Appeals

In order to better assist our providers, we’ve created appeal forms for various medical necessity and billing disputes. Before submitting an appeal, please review the provider appeals process to determine the level of appeal you need to file.

• Dental Provider Reconsideration Form – Use this form to request review of a dental claim that has processed with an adverse determination. This form is applicable to State Dental and BlueCross commercial dental plans only. 
• Dialysis Erythropoietin (EPO) Appeal Request Form – Use this form when providing medical documentation to support medical necessity dosage given. 
• Provider Reconsideration Form – Use this form to request review of a claim that has processed with an adverse determination. It ensures the medical information and supporting documentation you fax or mail gets to the right area at BlueCross. You can also use this guide to help you.