2019 News
October 2019 Medical Policy Updates
Medical Policies | October 31, 2019
Here are the medical policy updates that were made in October 2019.
National Drug Code (NDC) Reminder
Pharmacy,Claims | December 30, 2019
We require providers to file a valid NDC with the unit of measure and quantity for all professional and outpatient administered drug lines.
Walk-in Retail Health Clinic
Claims | December 13, 2019
Services rendered at a retail health location should be filed with the appropriate Place of Service (POS) value, Walk-in Retail Health Clinic (17).
Maternity Services and Claims
Claims | November 19, 2019
First confirmation of pregnancy visit is included in the global maternity reimbursement in accordance with our medical policy CAM 366.
Updated Information on Submission of Health Insurance Prospective Payment System (HIPPS) Codes to Medicare Advantage Encounter Data System
Medicare Advantage | November 4, 2019
Medicare Advantage Organizations (MAOs) are required to submit Submission of Health Insurance Prospective Payment System (HIPPS) codes on skilled nursing facility (SNF) and home health (HH) encounters submitted with “from” dates of service as of July 1, 2014 or later.
November 2019 Medical Policy Updates
Medical Policies | October 31, 2019
These are the medical policy updates that were made in November 2019.
A New Way to Manage Prescription and Medical Specialty Drugs
Pharmacy,Prior Authorization,Serving Members | October 23, 2019
BlueCross BlueShield of South Carolina has simplified the way you prescribe medicine and get prior authorizations.
Urgent Notice For Podiatrists Regarding Foot Soak Prescription Medications
Serving Members,Claims | October 15, 2019
We learned of direct marketing campaigns for foot soaks used to treat foot disorders.
Monthly Care Opportunity Reports
Serving Members | October 15, 2019
In the coming weeks, you may begin receiving automated monthly care opportunity reports from Navigator@bcbssc.com.
September 2019 Medical Policy Updates
Medical Policies | September 30, 2019
These are the medical policy updates that were made in September 2019.
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan Health Insurance Marketplaces: Small Group Plans Reminder
Serving Members | September 4, 2019
Small group products (available to businesses with two to 50 employees) continue to access the broad commercial networks (BlueCross Preferred Blue® network or BlueChoice® HealthPlan networks).
August 2019 Medical Policy Updates
Medical Policies | August 31, 2019
These are the medical policy updates that were made in August 2019.
ClaimsXten Reminder for Bilateral Procedures
Claims | August 29, 2019
If you have been receiving denials for bilateral procedure codes such as procedure code 19318, here is how to bill those procedure codes.
July 2019 Medical Policy Updates
Medical Policies | July 31, 2019
These are the medical policy updates that were made in July 2019.
HEDIS: Supplying Discharge Summaries
Serving Members,Claims | July 16, 2019
In order to comply with HEDIS requirements, we may request discharge summaries from facilities for our members within 24 hours of discharge.
Important Member Identification (ID) Card Information
BlueCard,Serving Members | July 10, 2019
The three character prefix on a member ID card is a foundational component of the BlueCard® Program.
BlueCross Medicare Advantage: Medical Records Signature Requirements
Medicare Advantage | July 9, 2019
Medical records submitted for BlueCross BlueShield of South Carolina Medicare Advantage members must include a signed order.
June 2019 Medical Policy Updates
Medical Policies | June 30, 2019
Here are the medical policy updates that were made in June 2019.
Policy Revision Notice: CAM 009 – Allergy Immunotherapy
Medical Policies | June 26, 2019
We will implement a medical policy revision to CAM 009 – Allergy Immunotherapy.
2019 Medicare Advantage (MA) PPO Network Sharing
Medicare Advantage,Serving Members,Claims | June 12, 2019
Here are some FAQs about 2019 Medicare Advantage (MA) PPO Network Sharing.
Casting and Splint Supplies
Claims,Medical Policies | June 11, 2019
We have adopted the Centers for Medicare & Medicaid (CMS) coding guidelines for casting and splint supplies administered by practitioners.
Physical and Wellness Exams for Medicare Advantage Members
Medicare Advantage,Serving Members | June 6, 2019
BlueCross BlueShield of South Carolina has preventive benefits for Medicare Advantage members in addition to the standard Medicare Part B benefits.
Medical Record Requests for Centers for Medicare & Medicaid Services (CMS) Audit
Serving Members | June 3, 2019
We will begin requesting medical records from some providers as part of the HHS annual RADV audit.
May 2019 Medical Policy Updates
Medical Policies | May 31, 2019
Here are the medical policy updates that were made in May 2019.
Warning to Providers Regarding Fraudulent Prescription Scam
Serving Members | May 31, 2019
BlueCross BlueShield of South Carolina’s Special Investigations Unit is aware of a new scam involving the fraudulent telemarketing of prescription medications.
Update to Claims Logic: CAM 20406 Testing for Diagnosis of Helicobacter Pylori
Medical Policies | May 22, 2019
Effective Aug. 15, 2019, we will no longer reimburse CPT 83009 and 86677 in accordance with the medical policy, Testing for Diagnosis of Helicobacter Pylori.
April 2019 Medical Policy Updates
Medical Policies | April 30, 2019
Here are the medical policy updates that were made in April 2019.
Remittance Advice Remark Code (RARC) N382: Missing/Incomplete/Invalid Patient Identifier
Claims | May 1, 2019
BlueCross BlueShield of South Carolina coordinates with other Blue Plans when members’ prefixes have recently changed. We monitor claims for the N382 denial and resubmit these claims with the correct prefix on your behalf.
New Medical Policy: Parathyroid Hormone, Phosphorus, Calcium and Magnesium Testing
Medical Policies | April 26, 2019
Effective July 1, 2019, we will implement a new medical policy addressing the criteria for coverage of parathyroid hormone (PTH), phosphorus, calcium and magnesium testing, CAM 217 – Parathyroid Hormone, Phosphorus, Calcium and Magnesium Testing.
March 2019 Medical Policy Updates
Medical Policies | March 31, 2019
Here are the medical policy updates that were made in March 2019.
Update to Claims Logic: Rapid Antigen Diagnostic Testing (RADT) for Streptococcal Infection
Claims,Medical Policies | March 14, 2019
We recently reviewed how our claims system applies benefits for RADT for streptococcal infection in symptomatic children.
February 2019 Medical Policy Updates
Medical Policies | February 28, 2019
Here are the medical policy updates that were made in February 2019.
January 2019 Medical Policy Updates
Medical Policies | January 31, 2019
Here are the medical policy updates that were made in January 2019.
New for Publix Members: Applied Behavioral Analysis Therapy Benefits
Serving Members | February 7, 2019
Applied Behavioral Analysis (ABA) therapy benefits are now available to Publix members.
New Dental Network Provider
Dental | February 5, 2019
Holley Endodontics, with locations in Greenville and Greenwood, has joined the BlueCross Dental Network.
Prior Authorization Changes
Prior Authorization | January 30, 2019
BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan no longer require prior authorization for certain codes.
ClaimsXten Implementation: March 2, 2019
Claims | January 29, 2019
We will upgrade our code-auditing system from ClaimCheck® to ClaimsXtenTM during the first quarter of 2019.
Medicare Part D: Drug Management Program and Safety Alerts
Pharmacy | January 7, 2019
The Center for Medicaid and Medicare Services (CMS) finalized the framework under which Medicare Part D plan sponsors may adopt drug management programs (DMPs) and announced new safety alerts to further help prevent and combat opioid overuse.
Provider Enrollment Process Enhancements
Enrollment | January 3, 2019
BlueCross BlueShield of South Carolina, BlueChoice® HealthPlan and Healthy Blue, have streamlined the Provider Enrollment Process to improve the credentialing experience.
2019 News
December 29, 2020
null
December 2019 Medical Policy Updates
Medical Policies | December 31, 2019
Here are the medical policy updates that were made in December 2019.