How can providers get claim status and/or the first processed explanation of benefits without contacting the home plan?

You can get claim status using My Insurance Manager^SM. You should check the claim's status prior to refiling any claims. Refiling claims within 30 days of the previously filed claim may not allow the home plan enough time to process the initial claim and can cause further delays.

Our health care system has several locations that use the same tax ID when submitting claims. How do we get our claims to process under the correct NPI and not under the tax ID so that you send payments to the accurate location?

When filing your claims, you should use the NPI for the location where the services are rendered.

What action can I take if an out-of-area member’s claim was bundled?

Physicians and physician groups may request a provider reconsideration if they disagree with BlueCross’ adjudication of a claim. You can find more information by reading about the provider appeals process.

How can the Blue Plans’ communication with providers be improved?

Blue Plans, including BlueCross BlueShield of South Carolina, are constantly developing ways to service members and providers in a timely manner. You can use our electronic services for fast and easy access to verifying eligibility, getting prior authorization, verifying claim status, claims submission and more. Provider Services representatives are only available for those inquiries that cannot be answered by querying the VRU or using our self-service web portal.

Why can’t I view group numbers, deductible and out-of-pocket information for other plans when using My Insurance Manager to verify eligibility?

The member’s home plan holds the patient’s membership and benefits information. My Insurance Manager is a web tool specific to BlueCross BlueShield of South Carolina. It does provide general eligibility and benefits information for other Blue Plan members. The information we receive for members from other plans may not contain all of the information you are accustomed to seeing when viewing a South Carolina member in My Insurance Manager. If there is additional information you need regarding the member’s benefits, you should contact the member’s home plan.

How does the provider's financial responsibility requirement impact providers?

You will be responsible for getting prior authorization for inpatient facility services for out-of-area members. The member will not be responsible when prior authorization is required but not received for inpatient services. BlueCard members will now be treated the same as local Blue Plan members. Failure to get necessary prior authorizations will result in claim penalties or denials.

Is the Return Coverage page form for medical records available on the website?

No, the Return Coverage page is not yet available on our website. It is included as the fourth page of a medical record request you may receive from BlueCross BlueShield of South Carolina.

If you request records via a response from My Insurance Manager, is there a specific form for providers to submit medical records?

Complete a Medical Review Form, found on our website in the Forms section. Attach the applicable medical records and supporting information to the form. Fax or mail the form and supporting documents to the appropriate service area.

When are providers supposed to receive medical record requests?

Providers may receive requests for medical records as needed for claims-related purposes and non-claims related matters that support our quality programs.

Why does it take so long to submit claims from host to home plan?

BlueCross applies pricing according to the provider’s contract and forwards the claim electronically to the member’s home plan. The home plan processes according to the member’s benefits and transmits data back to BlueCross. This generally takes 30 days.