Provider Web Tools FAQs

Here you can find some questions we've received from the provider community about these topics. If you have a question you would like to submit please contact us.

  • What is My Insurance ManagerSM
    My Insurance Manager is a safe and secure online tool you can use to access:
          - Benefits and Eligibility
          - Claims Entry
          - Preauthorization Request and Status
          - Claims Status
          - Electronic Data Interchange (EDI) Claims Reports
          - Remittance Information
          - Other Health Insurance
          - View Primary Care Physician
          - Your Patient Directory
          - Your Mailbox

           

  • How do I verify a member's benefits and eligibility?
    Check eligibility and benefits by logging into My Insurance Manager.
  • What is a Superbill?
    The Superbill tool in My Insurance Manager is ideal for providers who want to submit primary claims for one date of service only. You can create and store your Superbill online, then use it to submit a professional Web claim with a minimum of keystrokes. It takes only seconds to submit a claim to us and you will receive instant claim disposition!
  • How do I check the status of a claim?
    You can check claim status in My Insurance Manager using the Claim Status function. For information on how to use any of the features, go to our Provider Tools section or contact your provider advocate.
  • Should I re-submit a claim if I do not receive payment?
    No. If you have not received payment for a claim, do not resubmit the claim. We will deny it as a duplicate. This also causes member confusion because of multiple Explanations of Benefits (EOBs). You should always check claim status through My Insurance Manager. In some cases, a claim may pend because medical review or additional information is necessary. We will contact you when we need additional information to finalize the claim.
  • Is there any other way we can communicate directly with BlueCross BlueShield of South Carolina's Provider Services department?
    Use of our automated response tools is the most efficient way to get patient benefit information and claim status. Provider Services representatives are only available for inquiries that you cannot get answers to by querying the voice response unit (VRU) or using My Insurance Manager. Ask Provider Services is a feature in My Insurance Manager you can also use to have a Provider Services representative respond to your question.
  • My Insurance Manager requires the patient’s ID and date of birth (DOB) to search for benefits. Can My Insurance Manager allow providers to search for member benefits using any combination of their full name, DOB or ID?
    At this time that is not an available feature in My Insurance Manager.
  • Does BlueCross have a Web link or listing with updated prefixes for all Blue Plans?
    We do not have an all-inclusive list of each home Plan’s prefixes. To determine which network you should use for a specific prefix, you can use the National Doctor and Hospital Finder available on the Blue Cross and Blue Shield Association’s website at http://provider.bcbs.com/.
  • How can we receive our remits for individual offices according to the National Provider Identifier (NPI)?
    Remits are available through My Remit Manager. With My Remit Manager, you can build historical, member-specific remittances that allow you to sort, view and print remits online. My Remit Manager is available to all providers who have electronic funds transfer (EFT). You can view the My Remit Manager user guide and tutorial on our My Remit Manager page.    

     

    We will continue to update the images of paper remits currently available through My Insurance Manager daily.

     

  • How does My Insurance Manager differ from the secure provider portal on the BlueChoice HealthPlan Medicaid website ?
    The ProviderAccess provider portal available at www.BlueChoiceSCMedicaid.com is very similar to My Insurance Manager. It allows providers to review claims, check if a member is eligible and print out reports. The biggest difference is you cannot get BlueChoice Medicaid information through My Insurance Manager or get any commercial lines of business for BlueCross and BlueChoice HealthPlan of South Carolina information using ProviderAccess.
  • What should I do to avoid claim denials or withheld payments because of a patient's missing other health insurance (OHI) update and/or accident questionnaire?
    At the beginning of each new year, we require our members to update their OHI information. You can make it easy by giving members computer access right in your office. Ask them to visit www.SouthCarolinaBlues.com and log into My Health Toolkit® to update their information. If you prefer, you can download a hard copy of the Other Health/Dental Insurance Questionnaire. You can save this form on your computer and email it to members as needed. A Spanish version of this form is also available.  

     

    Federal Employee Program (FEP) members do not currently have access to the form in My Health Toolkit and will need to complete a hard copy of the FEP Other Health Insurance Questionnaire.

    Members should complete a Subrogation Questionnaire when they receive treatment for an injury or illness that is work-related or the result of an accident.

     

     

    All of these forms are available on our website.

  • How do I file a secondary claim using My Insurance Manager?
    To file a secondary claim, from the Patient Care menu, choose either Professional or Institutional Claim Entry. On the Plan Information page, for “Is the selected plan the primary payer?” choose No. Continue entering your provider, patient and claim information. After you’ve entered your claim line information, you will be asked for the other payer information. You can choose another payer by selecting the link or manually entering the payer information. Enter the patient’s other insurance information in the required fields. You have the option of entering the Other Payer Claim Information and Adjudication Information. For professional claims, we recommend you enter the other payer money as a line-level adjustment. For institutional claims, we recommend you enter the other payer money as a header-level adjustment.

    Please note: We automatically default to these options based on whether you choose to file a professional or institutional claim.

    Enter the amount under Payer Paid. The Other Payer Line Selection page lets you review the other payer information you've entered and make corrections if necessary. If the information is correct, select Continue and you can review all the claim information before submitting it for processing.

  • How long does it take to get a referral or authorization?
    You should receive a response in 24-48 hours.
  • Is there a one-question limit when using STATChatSM?
    No. You can ask as many questions as you like related to one member’s account. Using STATChat rewards you for using our website to try to get the information you need. The patient information, however, prepopulates onto the Provider Service representative’s screen, so he or she is restricted to only answering questions related to the member from your original inquiry.
  • Have you added home health to the Fast Track option on the web?
    No, home health is not available as a Fast Track option.
    BlueChoice® HealthPlan of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.