Resources

Find information, get answers to frequently asked questions and learn about new ways to help your patients stay healthy.

BlueCross BlueShield of South Carolina Resources

We want to make your interactions with BlueCross as easy and efficient as possible. Here are a few resources we've developed to help you get the information you need quickly:

  • Medical Forms Resource Center User Guide – Get instructions on how to use the Medical Forms Resource Center (MFRC). The MFRC is an online tool which allows you to submit precertification requests quickly.
  • Provider Validation: MD Checkup User Guide – Use the Provider Validation feature to verify and update your practice and physician demographic information electronically. The information you provide is used to maintain our online provider directories as well as our systems to ensure accurate claims processing. 
    Updated: Aug. 2019
  • Inpatient Non-Reimbursable Charge/Unbundling Policy – BlueCross and BlueChoice® implemented a policy October 1, 2018 to address charges considered to be non-reimbursable, unbundled or are otherwise not allowed to be billed separately. This policy is applicable only to inpatient charges and is not intended to impact care decisions.
  • 2019 Member Identification Card Guide – This guide provides you with an overview of our various plans and associated networks.
  • Preventive Care Guide – This guide provides an outline of the services the Affordable Care Act approves as preventive for non-grandfathered plans.
  • 2019 BlueCard® Manual – This manual provides you with an overview and describes the advantages of the program. It will also help guide you through eligibility verification, precertification and claims filing processes for out-of-area members. 
    Updated: June 2019
  • 2019 Dental Providers Administrative Office Manual –  This manual provides you with an overview of dental benefits for our commercial, Federal Employee Program (FEP) Blue Dental, and State Dental and Dental Plus plans. We review the national Dental GRID program and give you information to help guide you through the credentialing and claims filing processes. GRID is a separate company that offers a dental network on behalf of BlueCross BlueShield of South Carolina. You can also look back at the 2018 Dental Providers Administrative Office Manual
    Updated: June 2019
  • 2019 Provider Office Administrative Manual –  This manual provides you with an overview of our benefit plans and medical management programs. It will also help guide you through the credentialing, claims filing and provider reconsideration processes. You can also look back at the 2018 Provider Office Administrative Manual
    Updated: June 2019
  •  2014 Urgent Care Facilities Reminders Revision – This handout provides top reminders for urgent care facilities.
  • Ancillary Claims Filing Reminders – This guide gives providers an overview of our filing guidelines for ancillary services. 
  • ClaimsXten: Correct Coding Initiative Reference Guide – Learn about our upgrade to ClaimsXten, a robust claim-auditing software designed to ensure health insurance claims are coded properly. Get details about the claim coding rules and benefits of this upgrade. 
    Updated: June 2019
  • Healthier Moms and Babies – Our maternity health magazine gives information about our maternity managed care programs, informs you of helpful tools to engage your patients and provides you with resources to integrate your patient care with our services. There are articles about the Birth Outcomes Initiative, using the Screening, Brief Intervention and Referral to Treatment (SBIRT) process in your practice, benefits of Centering Pregnancy and more.
  • How to Determine If You Are a Network Provider – This guide will show you how to use the Doctor and Hospital Finder to verify network access for BlueCross plans nationwide.
  • Improving Patient Satisfaction for Providers – This publication gives you information on how to improve patient satisfaction. It includes articles about care coordination, quality standards and opportunities for physician care improvement.  
  • Frequently Asked Questions – Have a question about BlueCross coverage or claims? Check here first.
  • Glossary – View the definitions for commonly used insurance terms.
  • Provider Quick Reference Card – Use this chart to identify the most efficient method to obtain benefit information and get preauthorization for certain services.
  • What You Need to Know About Claim Attachments – This guide provides you with an overview of the Claim Attachment feature in My Insurance ManagerSM. Use Claim Attachments to attach records or documents to claims that require additional documentation.
  • What You Need to Know About Medical Specialty Drug Prior Authorizations – This guide provides you with an overview of the specialty medical drugs prior authorization requirements and the steps to get prior authorizations.
  • What You Need to Know About Skilled Nursing Facilities – This booklet gives an overview of procedures, authorization requirements and claims filing guidelines for skilled nursing facilities (SNFs).
  • State Dental Plan Fee Schedule – Learn how to get the most recent State Dental Plan fee information. 
  • State Health Plan Fee Schedule – Learn how to get the most recent State Health Plan fee information.  

Find more ways to streamline your business with BlueCross in our Provider Tools section.

Patient Resources

Your number one priority is to get patients healthy and keep them that way. We're here to help. We've compiled a few resources to help you manage your patients' care: