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Publix PPO Members Require Precertification of Outpatient Services

February 15, 2011

Publix PPO Members Require Precertification of Outpatient Services

Effective January 1, 2011, all outpatient services, with the exception of  preventive services, labs, X-rays, emergency room and urgent care will require precertification for Publix members with a BlueCross BlueShield PPO. This will also include all physical, occupational and speech therapy services rendered in an outpatient or office setting.  

Getting Precertification

Precertification must be obtained from BlueCross BlueShield of South Carolina prior to members receiving any outpatient services rendered at an ambulatory surgical center, hospital or other outpatient facility. This will not apply to office visits conducted by family doctors or specialists with the exception of therapeutic services as listed above. Failure to request outpatient precertification will result in the denial of charges and become member liability.  

Identifying Publix Group Members

To identify Publix members see this sample card. Copayment information is on the front of the card. Alpha prefix “PBB” will be at the beginning of the member’s identification number.

Eligibility, Benefits and Claims Filing Information

Use My Insurance ManagerSM to verify eligibility and benefits, preauthorize services, check authorization status, file claims and check claim status. Access My Insurance Manager through our website, www.SouthCarolinaBlues.com. You can also request precertification by calling 888-376-6544.

If you have questions about this bulletin, contact Provider Education at 800-288-2227, ext. 44730. You can also e-mail Provider Education by using the “Contact Provider Advocate” form on our website under Providers/Contact Us.

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