2021 Annual Provider Summit Frequently Asked Questions
You asked great questions during the 2021 Virtual Annual Provider Summit. Here are a few:
How long will coverage for COVID-19 last?
We cannot provide a definitive answer at this point. However, we will keep the provider community abreast of any changes via newsletters or bulletins. Be sure to sign up for the monthly newsletters and always check the bulletins located on www.SouthCarolinaBlues.com or www.BlueChoiceSC.com.
Were telehealth services expanded past Dec. 31, 2020?
The expansion of telehealth services has been extended until further notice. Ongoing coverage will be continually assessed during the COVID-19 pandemic. Be sure to refer to CAM 176 on our Medical Policies page for further guidance.
For high dollar claims review, how can the requested information be submitted?
You can submit itemized bills for high dollar claims reviews (when requested) via My Insurance Manager℠ using the claims attachment feature. If medical records are needed, you will receive a separate request that will provide instructions on how to submit.
For authorizations, does My Insurance Manager℠ indicate the PDF limitations on the website when submitting documentation?
Yes, it does. There is a limit of 10 attachments with a maximum of 30MB, which is equivalent to 10,000 pages.
Does Companion Benefit Alternatives (CBA) follow the telehealth guidelines?
Yes, they do. If the member has telehealth coverage, the claims will process and pay according to the member’s benefits.
How can we determine benefit coverage for a procedure?
You can use My Insurance Manager℠ to check the benefit coverage for procedures. You can request general benefit details, benefits based on the type of service or enter a procedure code for specific benefits. You also have the option of contacting Provider Services at 1-800-868-2510.
Who do we contact when the Home plan and the Local plan are not aligned with the payment received for the patient?
As a South Carolina provider, you would reach out to BlueCross BlueShield of South Carolina for assistance.
How would Healthy Blue℠ members get in contact with someone regarding free benefits (e.g., Sam’s Club membership, diapers, etc.)?
A full list of the additional benefits for Healthy Blue℠ members (at no cost) can be located on www.HealthyBlueSC.com. The members can redeem some of these benefits online through their secure account. They can check their eligibility on the Benefit Reward Hub or call the Customer Care Center at 1-866-781-5094.
Will BlueCross BlueShield Exchange members be required to use Optum Specialty for specialty drugs? Will those items no longer be available for buy and bill in the office?
There are no changes to the buy and bill process for the medical specialty drugs. You will continue to get prior authorizations via MBMNow/Optum and submit your claims to BlueCross BlueShield of South Carolina for processing under the medical benefit.
Why do claims deny when billed with a covered diagnosis, per the CAM policy?
The procedure and diagnosis codes listed in the medical policies are included only as general reference and may not be all inclusive. The services being rendered must meet the medical necessity criteria that is also listed in the medical policies.
Why are the payer IDs different for Healthy Blue℠ and BlueChoice® HealthPlan?
The payer IDs are different because these are two separate health plans. The payer ID for Health Blue℠ is 00403, while the payer ID for BlueChoice® is 00922.
Can the refund number be used to question why a recoupment was processed on a claim?
Yes, the refund number can be used. If you need assistance with refunds, contact Provider Services at 1-800-868-2510, Option 4.
Is Provider Enrollment able to open secured emails?
Yes, they can.
How long does the provider enrollment process take?
The timeframe for the enrollment process could vary, as it solely depends on whether all the required documentation is received from the beginning. If so, the enrollment packet is sent to the Credentialing Committee for review; if approved, you will be notified via email and sent a welcome packet. Once the email is received with the effective date(s), you can accept patients and file claims.
Can we request training for our office from the Quality Navigator?
Yes, you can by sending an email to NAVIGATOR@bcbssc.com.
How often are updates made to the pharmacy formularies?
Usually, reviews and updates are done quarterly unless there is an immediate need.
How do I know if an authorization is required for a service?
Always check the member’s eligibility and benefits prior to rendering services to determine whether an authorization is required.
What does BlueCross BlueShield of South Carolina do with the Quality information collected?
The Quality data helps with quality improvements and helps to identify true care opportunities for your patients, our members.
Who do we call for questions about claims for members with another Blue plan?
As a South Carolina provider, you would contact BlueCross BlueShield of South Carolina for assistance.
When does phase two of ClaimsXten go into effect?
Phase two of ClaimsXten went into effect on January 24, 2021.
When will the 2021 ID Card Guide be available?
The 2021 ID Card Guide is currently posted on our website. Please visit www.SouthCarolinaBlues.com to see the updates.
Are we able to see members from any plan participating in the Dental GRID?
Yes, the Dental GRID allows dentists to see members from other participating BlueCross BlueShield plans at the local plan reimbursement levels.
How do I get access to the Healthy Blue℠ newsletter (BlueBlast)?
To get access, reach out to your Education representative and they will be able to get you signed up.
Can I review remittances in My Insurance Manager℠?
You can review your remittances via My Remit Manager℠, which you can access through My Insurance Manager℠.
How long does the provider reconsideration review take?
We ask providers to allow up to 30-45 business days for the review process to be completed.