2018 News
State Health Plan: Express Scripts and the Advanced Opioid Management Program
Pharmacy | December 31, 2018
Express Scripts, the pharmacy benefits manager (PBM) for the State Health Plan, implemented an Advanced Opioid Management (AOM) program on March 1, 2018.
State Health Plan Now Offering Naturally Slim
Benefits | December 10, 2018
The State Health Plan is now offering Naturally Slim to its members at no charge. Naturally Slim is a 10-week, online behavior modification program proven to deliver sustainable weight loss and reverse obesity, prediabetes and metabolic syndrome.
FEP Blue Focus: 2019 Prior Authorization Requirements
Prior Authorization | December 6, 2018
The Federal Employee Program (FEP) has updated its list of services that require prior approval for the 2019 FEP Blue Focus Plan.
State Health Plan – 2018 Updated Colonoscopy Reimbursement Codes
Benefits | October 23, 2018
As of Jan. 1, 2016, State Health Plan (SHP) primary members can receive covered routine and diagnostic colonoscopies with no member cost share amounts.
Seasonal Flu Vaccines for Blue Essentials Members
Pharmacy | October 10, 2018
Now is the perfect time for you to encourage your patients to get their flu vaccinations.
Claim Edits 251 and B57
Claims | September 26, 2018
BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan recently made changes for BlueCross member ID’s. These changes impacted claims that have not been submitted with the correct carrier code based on members’ ID prefix.
New Medical Policy: Urine Culture Testing for Bacteria
Medical Policies | September 19, 2018
Bacteriuria is the presence of bacteria in the urine. Typically, bacteriuria and pyuria are present and can be both symptomatic and asymptomatic Urinary Tract Infections (UTls).
High-Dollar Claim Reviews
Claims | September 19, 2018
Beginning Oct. 1, 2018, BlueCross BlueShield South Carolina and BlueChoice® HealthPlan will conduct some of the routine audit reviews on high-dollar claims on a pre-pay basis and itemized bills and medical records may be requested from your facility.
File a Corrected Claim to Get Paid
Claims | September 19, 2018
After you submit a claim with BlueCross BlueShield of South Carolina and identify a change you need to make on the claim, be sure to file a corrected claim.
Credentialing and Provider File Update Status Requests
Enrollment | September 19, 2018
If you’ve submitted a credentialing application or other provider file update request (Request to Add or Terminate Practitioner Affiliation, Change of Address Form, NPI Provider Notification Form, etc.), and are in need of a status update, please contact your BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan Provider Relations and Education Advocate.
New Medical Policy: Alcohol Injections for the Treatment of Peripheral Neuromas
Medical Policies | August 28, 2018
Morton neuroma is a common and painful compression neuropathy of the dorsal foot that is usually treated with conservative measures, surgery, or minimally invasive procedures.
New Medical Policy: General Inflammation Testing
Medical Policies | August 28, 2018
Inflammatory response can occur due to tissue injury and/or various disorders to include arthritis, lupus, and infection.
New Medical Policy: Folate Testing
Medical Policies | August 2, 2018
Folate, or vitamin B9, is a generic term for a water-soluble vitamin obtained from the diet that is involved in the transfer of methyl groups in multiple biochemical metabolic pathways.
Centers for Medicare & Medicaid Services (CMS) Audit
Quality (HEDIS) | June 26, 2018
BlueCross and BlueChoice® have begun requesting medical records from some providers as part of the U.S. Department of Health and Human Services’ (HHS) annual Risk Adjustment Data Validation (RADV) audit.
New Medical Policy: Pancreatic Enzyme Testing for Acute Pancreatitis
Medical Policies | June 25, 2018
Pancreatitis is an inflammation of pancreatic tissue and can be either acute or chronic.
Claim Numbers With Blank Spaces
Claims | June 21, 2018
BlueCross and BlueChoice encountered a system issue for claims submitted between Jan. 1, 2018 and Jan. 2, 2018 which caused claim numbers to be generated with blank spaces in the third and fourth byte positions (i.e., 82 0XGGG0000).
Aimovig: A New Prescription Drug for Migraines
Pharmacy | June 14, 2018
The Food and Drug Administration (FDA) recently approved Aimovig, a new self-injectable drug to prevent migraine headaches.
S.C. Providers Could See Record Requests from Inovalon
Quality (HEDIS) | June 8, 2018
Some BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan providers are receiving requests for medical records from Inovalon, the Blue Cross and Blue Shield Association’s medical record retrieval vendor for all out-of-area requests.
Medical Policy Update: Cardiac Biomarkers for Myocardial Infarction
Medical Policies | June 1, 2018
Cardiac biomarkers are the biochemical markers released in blood from the injured myocardial tissue. They become elevated in blood after a certain period and can be measured.
Providers Urged to Ensure E&M Codes Are Filed Correctly
Claims | May 22, 2018
BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan are asking providers to ensure claims with Evaluation and Management (E&M) CPT codes are submitted correctly.
Pharmacy: New Review Process for Prescription Drugs Korlym and Xyrem
Pharmacy | May 3, 2018
Effective July 1, 2018, BlueCross BlueShield of South Carolina and BlueChoice® Healthplan will conduct all utilization reviews for prescribed drugs Korlym and Xyrem.
New Provider Credentialing Section Added to BlueCross Website
Enrollment | April 24, 2018
South Carolina health care providers now have access to BlueCross BlueShield of South Carolina credentialing forms and information in a centralized section recently added to the company’s website, www.SouthCarolinaBlues.com.
M.D. Checkup is here!
Enrollment | April 23, 2018
The electronic provider validation tool is now available within My Insurance Manager, our secure provider portal.
BlueCross Announces ClaimsXten Upgrade for 2019
Claims | April 9, 2018
BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan of South Carolina will upgrade their code-auditing system from ClaimCheck® to ClaimsXtenTM, Change Healthcare’s next-generation solution for ensuring proper coding on health insurance claims.
Ameritox, Ltd.: Network Update
Laboratory Medical Benefits | March 19, 2018
BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan of South Carolina use Avalon Healthcare Solutions to establish and maintain a network of laboratories to serve BlueCross and BlueChoice® members.
Provider Incentives Announced for Medicare Advantage Plans
Medicare Advantage,Quality (HEDIS) | March 13, 2018
BlueCross Medicare Advantage network providers can now earn incentives for submitting accurate CPT Category II codes for specific services that contribute to positive health outcomes and high-quality care.
Opioid Management Program Effective April 1, 2018
Pharmacy | January 11, 2018
BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan are dedicated to reducing the over-prescribing of opioids to ultimately help reduce the number of new opioid addicts and deaths.
2018 End Medical Policy Updates
Medical Policies | December 31, 2018
Here are the medical policy updates that were made at the end of 2018.