Can the Other Health Insurance (OHI) Questionnaire be submitted with the claim?

Only send the OHI questionnaire when requested. The form is available in the Forms sections of www.SouthCarolinaBlues.com and www.BlueChoiceSC.com. Make sure the member signs the form before you submit by mail or fax to the correct plan at the bottom of the form. You can also ask the member to submit the information via My Health Toolkit^®, a secure online application for member self-service. 

Note: State Health Plan now only accepts the OHI Questionnaire from members.

Can an Accident/Subrogation Questionnaire be submitted along with a claim for services rendered in the emergency room?

Only send the Accident Questionnaire when requested and make sure the member signs the form before you submit by mail or fax. You may also give the form to the patient to fill out and submit as soon as they are able. The form is available in the Forms sections of www.SouthCarolinaBlues.com and www.BlueChoiceSC.com. 

Once the patient has submitted the OHI or Accident Questionnaires, when do the claims get adjusted?

The forms are reviewed by the designated areas, then claims are submitted for adjustment, if applicable. The adjustment times for each claim type can vary, however we ask that you allow 30 days to receive a remittance advice.

Is the birthday rule used to determine which plan is primary or secondary when a dependent is covered by both parents?

Yes, the parent whose birthday falls first in the calendar year holds the primary coverage for the dependent.

Were member information and current prior authorizations transferred from Novologix to My Business Manager Now (MBMNow)?

Yes, all member information and open or active prior authorizations were transferred to the MBMNow online tool.

How do I access the MBMNow tool?

You can access the MBMNow online tool through My Insurance Manager in the Precertification section. 

Did the State Health Plan also change to the new pharmacy benefit manager (PBM)?

No, the PBM for State Health Plan members will remain Express Scripts. However, prior authorizations for medical specialty drugs need to be made using the MBMNow online tool.

What electronic medical records (EMRs) are compatible with PreCheck MyScript?

PreCheck MyScript is in a variety of EMRs including, but not limited to, AllScripts, Athenahealth, DrFirst, MEDITECH, NewCrop, and select installations of Epic and Cerner. The tool is embedded in the e-prescribing work flow and may be referenced by a different name within the specific EMR such as “Real Time Benefit Check” or “myBenefit Check.”

Are notifications sent to providers when credentialing updates are needed?

Yes, we notify providers when a credentialing update is needed. If an update needs to be made, use the M.D. Checkup feature on My Insurance Manager.

How do I know which enrollment application to fill out?

Use the enrollment checklist located in the Provider Enrollment section of the website to determine which enrollment application to fill out.

How do we get in touch with the Provider Enrollment department?

You can fill out the Get Help form if you need assistance from Provider Enrollment and someone will reach out to you.

Can the Accident and OHI questionnaires be uploaded online in My Insurance Manager (MIM)?

Yes, if a claim requires the documentation you can go to the Claims Status page in MIM to upload the forms.

Note: State Health Plan now only accepts the OHI form from members.

How do I determine why you are requesting a refund of an overpayment?

To get information about refunds from overpayment, please contact Provider Services.

How do I see all the features available in My Remit Manager?

If you access My Remit Manager from MIM, you will see an abbreviated version. To utilize all the features available in My Remit Manager, please request access through Provider.Education@bcbssc.com.

If I have questions about an out-of-state member’s plan, who do I call?

You will call 1-800-676-BLUE(2583) to verify benefits for out-of-state members. We will provide you with the remittance advice and other assistance.

If a claim is pending for medical records, should a Provider Reconsideration Form be attached to the medical records?

A reconsideration form is only used to request a review of a claim that has processed with an adverse determination. It ensures the medical information and supporting documentation you fax or mail gets to the right area at BlueCross.