Financial and Appeals

Financial

We want to make your interactions with BlueCross BlueShield of South Carolina as easy and efficient as possible. Use these forms to save time and costs for your practice.

Appeals

In order to better assist our providers, we’ve created appeal forms for various medical necessity and billing disputes. Before submitting an appeal, please review the provider appeals process to determine the level of appeal you need to file.

  • Dental Provider Reconsideration Form – Use this form to request review of a dental claim that has processed with an adverse determination. This form is applicable to State Dental and BlueCross commercial dental plans only.
  • Dialysis Erythropoietin (EPO) Appeal Request Form – Use this form when providing medical documentation to support medical necessity dosage given.
  • Provider Reconsideration Form – Use this form to request 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.   
  • Provider Laboratory Reconsideration Form - This form is intended for use by laboratory professionals in South Carolina. Use this form to request review of a laboratory claim that has processed with an adverse determination. 

Helpful Financial and Appeals Information

Before submitting an appeal, please review these resources to determine the level of appeal you need to file.

  • EPO Guidelines – We follow the Epoetin Alfa (EPO) guidelines of the U.S. Food and Drug Administration (FDA). The FDA is an independent organization that provides health information on behalf of BlueCross.
  • Provider Reconsiderations – Get instructions about the provider reconsideration process for medical necessity and billing/coding disputes. Also, learn when it is appropriate for a provider to file for reconsideration.