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Information We Request From Members

June 06, 2014

This is a reminder of the types of information we sometimes request from members. Sometimes the claims you submit to us may pend until we receive certain information from our members. Once we receive and process the information, your claims will complete processing.

What Type of Information Do We Request from Members?

  • At the beginning of each year, we require our members to update their Other Health Insurance (OHI) information. This information lets us know if we need to coordinate our member's benefits with another insurance carrier. Members should complete the OHI questionnaire any time their insurance coverage changes. For example, if a spouse gets new employment during the middle of the year and provides coverage for the family, the member should complete a new OHI questionnaire. Likewise, if coverage with another company ends, the member should complete a new OHI questionnaire.
  • Members also complete a Subrogation Questionnaire when they receive treatment for an injury or illness that is work-related or the result of an accident. This information lets us know if we need to coordinate reimbursement for members' care with other parties.

How Do Members Complete This Information?

  • You can find the OHI questionnaire on our websites, www.SouthCarolinaBlues.com and www.BlueChoiceSC.com.
  • Members can also update their OHI information when they log into My Health Toolkit®. They can mail this questionnaire to us or call their customer service area.
  • The Subrogation Questionnaire is available at www.SouthCarolinaBlues.com for BlueCross BlueShield of South Carolina members. Trover Solutions, Inc. manages BlueChoice HealthPlan subrogation inquiries. Trover Solutions, Inc. is an independent company that provides medical service reviews on behalf of BlueChoice®. If you have subrogation questions about a BlueChoice member, please contact Trover Solutions, Inc. at 877-459-8696.

How Can Providers Help?

  • If your claim pends because we need this information from the member, you can ask the member to complete the questionnaire. We prefer to receive this information from the member. You can submit the questionnaire on the member's behalf only if we ask for it.
  • Submitting unsolicited questionnaires can cause a delay in claim processing or updating the member's information.
  • Make sure the member answered the questionnaire completely before sending it to the appropriate location.
  • Send the completed questionnaire to the appropriate department for processing to avoid routing delays. Each questionnaire identifies the department that processes the information. 

Note that many of our plans are what we refer to as "pay and chase." For these plans, if we have no OHI information on file or if the member is due to update this information, we will process the claim as primary and send the member a questionnaire. We will update our information on file:

  • If we receive the questionnaire back indicating no OHI exists.
  • If we receive the questionnaire back indicating another insurance carrier is secondary.
  • If we receive the questionnaire back indicating another insurance carrier is primary. In this case, we would also review claims history and request refunds as necessary.

If we do not receive a response to the questionnaire, we will continue to pay primary until we receive information to the contrary. We will continue to send the member OHI questionnaires until we receive a response.

If you have questions about this bulletin, please contact Provider Education at provider.education@bcbssc.com or by calling 803-264-4730.

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