- Benefits and Eligibility.
- Claims Entry.
- Pre-Authorization Request and Status.
- Claims Status.
- EDI Claims Reports.
- Remittance Information.
- Other Health Insurance.
- View Primary Care Physician.
- Your Patient Directory.
- Your Mailbox.
My Insurance Manager is safe, secure, simple and best of all, it’s free!
How do I verify a member’s benefits and eligibility information?
Physician's office visit copayments are listed on the member’s current ID card. You can also check eligibility and benefits by logging in to My Insurance Manager.
What should I collect from a BlueCross member?
You should collect the applicable patient responsibility (i.e., copayment or coinsurance, or deductible and coinsurance) from the member. Some plans have the same copayment ($15, $20, $25, etc.) for both in-network and out-of-network physician's office services. Other plans may have deductible and coinsurance for out-of-network physician's office services. Per your contract, please do not balance bill the member for the differences between your charges and the BlueCross allowed amount.
Where and how do I submit claims?
You should always submit claims electronically to BlueCross BlueShield of South Carolina. Be sure to include the member’s complete identification number when you submit the claim. The complete identification number includes the three-character alpha prefix (with the exception of the Federal Employee Program). Do not make up alpha prefixes. Submitting claims with incorrect or missing alpha prefixes and member identification numbers can result in processing delays, as well as claim denials.
For prompt payment, we encourage electronic claims submission. Claims should be transmitted in the HIPAA 837 format under the appropriate carrier codes.
You should complete all applicable claim information in full to ensure you receive accurate payment without delay. Our Supplemental Implementation Guides (SIGs) will help you file electronic claims. You can also file both professional and institutional claims (primary, secondary and corrected claims) in My Insurance Manager.
What is Superbill?
The Superbill tool in My Insurance Manager is ideal for providers who want to submit primary claims for one date of service only. You can create and store your Superbill online, then use it to submit a professional Web claim with a minimum of keystrokes. It takes only seconds to submit a claim to us and you will receive instant claim disposition!
How do I file Medicare Crossover Claims?
File the claim to your Medicare carrier for primary payment. BlueCross will not receive claim information for the member’s supplement plan (the secondary payer) until after Medicare has processed the claim and released it from the Medicare payment hold. GHI (the CMS vendor) normally will electronically forward Medicare secondary claims directly to the member’s supplement plan. Check the Medicare Remittance Notice to make sure GHI forwarded the claim. If it did, you do not need to take further action. The paper remittance notice will state "Claim information forwarded to: [Name of secondary payer]". The 835 (electronic remittance) record can also carry the secondary forwarding information. BlueCross will send you your payment or processing information after it receives the Medicare payment. Please allow 45 days from the primary payment date for the processing of the secondary claim. If the claim did not crossover electronically to the supplement plan, you can file the secondary claim to BlueCross BlueShield of South Carolina electronically using My Insurance Manager.
How do I check the status of a claim?
You can check claim status in My Insurance Manager using the "Claim Status" function. For information on how to use any features found on SouthCarolinaBlues.com, contact your Education Specialist.
Should I re-submit a claim if I do not receive payment?
No. If you have not received payment for a claim, do not resubmit the claim. It will be denied as a duplicate. This also causes member confusion because of multiple Explanations of Benefits (EOBs). You should always check claim status through My Insurance Manager. In some cases, a claim may pend because medical review or additional information is necessary. We will contact you when we need additional information in order to finalize the claim.
What steps should I take if I do not agree with the claim disposition?
If you do not agree with the disposition of your claim, you can submit a medical review request by using the Medical Review Request form. BlueCross will re-evaluate the payment and, if appropriate, reprocess the claim(s) in question to allow additional benefits.
Who do I contact with claims questions?
We offer two features within My Insurance Manager to expedite claim questions for providers:
- Ask Provider Services
- STATchatSM
For information on how to use the Ask Provider Services and STATchat features, contact your Education Specialist.
When an employee with a My Insurance Manager profile ends employment with my office, what should I do?
Please contact your education specialist to have the profile deleted.
What is My Remit Manager?
My Remit Manager is an online tool you can use to search remits by patient, account number and check number. It is free to all providers with Electronic Funds Transfer (EFT) and who will allow us to eliminate paper remittance advices.
When should I contact my provider education specialist?
If you have a training request or question that is not related to specific claim disposition, or member information, please contact your Education Specialist.
Does BlueCross require prior authorization?
BlueCross requests notification for any admission to a hospital or skilled nursing facility. This notification enables the member to access optional benefits such as Case Management and Disease Management programs, along with discharge planning.
Other services may also require prior authorization. You can get prior authorization using the Authorization/Pre-Certification/Referral link in My Insurance Manager. You can submit prior authorization requests for BlueCross, State Health Plan and BlueChoice HealthPlan. This feature also includes the Referral and Authorization Status functions.
Note: Prior authorizations do not guarantee payment of benefits. Claim payments are subject to the rules of the plan.
If I need to refer members for other services, what network should I use?
BlueCross members use our network for in-network benefits with lower out-of-pocket expenses. Therefore, physicians and providers, in accordance with their best medical judgment, should refer patients to network providers whenever possible. Use our online Provider Directory to find physicians in our networks.
More FAQs
Still have questions? Check out our other FAQ pages.
FAQs about the 837
FAQs on Terms and Conditions and "Deemed" Providers
HIPAA FAQs
Medicare Advantage and Medicare-related Claims FAQs
National Provider Identifier (NPI) FAQs
Technical Support Frequently Asked Questions
For Ambulatory Payment Classification (APC) FAQs, please log in to My Insurance Manager and select System News from the home page.