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Sometimes after forwarding an out-of-state claim to the home plan, BlueCross BlueShield of South Carolina will receive a request for more information from that plan. When this happens, we then send the form below to you.

Send this form and accompanying medical records to us ONLY when we request them or when you receive a remittance advice stating that additional medical information is necessary to process the claim.

Please send a copy of the form with the medical records to the fax number listed on the form.

Download the BlueCard^® Members: Request for Additional Information form  now.