Sept. 10, 2021

To ensure you are providing the best service to your patients, our members, it is important to understand how to locate pertinent information such as eligibility, benefits and claims information.  These components are important to your patients and you want to ensure the information being provided is always accurate.

Eligibility and Benefits

Eligibility and benefits should be verified prior to rendering services.  This allows you to provide the patient with accurate information such as cost-shares, authorization requirements, and service limitations.  My Insurance Manager℠ is an online tool that can quickly provide you with these details and you can avoid calling into the customer service line.

General benefits can be obtained for the patient or you can search by the type of service or the procedure code (which is the best option).  Keep in mind that the appropriate Medicare modifier must be entered when checking benefits using the procedure code.  Failure to use the appropriate Medicare modifier when checking benefits may result in the incorrect benefits being displayed.

When the benefits are displayed, you will also be provided with any service maximums or limitations and will be advised if prior authorization is required.  Again, these are important details that should be explained to the member at the time of service.

Claims

We encourage you to submit claims for Medicare Advantage patients within 12 months of the date of service to ensure prompt payment and to avoid delays that may result from expiration of timely filing requirements.  In additions to filing the standard CPT and HCPCS codes, we highly recommend the use of CPT II codes to enhance billing accuracy.  With the filing of certain CPT II codes, providers are eligible for incentive payments through the Medicare Advantage quality program.

The preferred method for submitting claims is electronically, and you can do this using the electronic payer ID 00C63.  However, if claims need to be mailed in, please use the following address:

Medicare Advantage

P.O. Box 100191

Columbia, SC 29202

For more information, please be sure to review the Medicare Advantage resources available on www.SouthCarolinaBlues.com.  You can also contact Provider Education with any questions you may have using the Provider Education Contact Form located on the same website.