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Provider Web Tools

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

Agenda

• Welcome and Introductions

• South Carolina Blues Provider Pages

• BlueChoice® HealthPlan Provider Pages

• Doctor and Hospital Finder

• My Insurance ManagerSM

• My Remit Manager

• Additional Resources


www.SouthCarolinaBlues.com www.BlueChoicesc.com

South Carolina Blues

http://www.southcarolinablues.com/

http://www.bluechoicesc.com/


Education Center

- BlueCard

- Medical Policies

- Precertification

- Training Manuals

- Webinars



Forms

- Financial and Appeals

- Prescription Drugs

- Credentialing/Provider Updates

- Specialties/Other



Quality Initiatives

- About

- Medical Policies and Clinical Guidelines

- My Health Essentials

- Patient-Centered Medical Home

- Recognition Programs

- Healthcare Effectiveness Data and Information Set (HEDIS)



Prescription Drug Information

- Drug Lists

- Electronic Prescribing

- Medicare Part D Resource Center

- Other Resources



The Centers for Medicare & Medicaid Services (CMS) requires our providers who participate in the BlueCross Medicare Advantage network to complete compliance training annually.

After you complete the compliance training, a certificate of completion will generate. You should print and retain this certification to validate that annual training has occurred for all staff.

You will also need to complete the BlueCross compliance attestation or submit a copy of the CMS compliance certificate to us by emailing [email protected] or by faxing to 803-264-8223.


http://web.southcarolinablues.com/UserFiles/scblues/Documents/Providers/MedAdv Attestation Form 012916.pdf

mailto:[email protected]


HIPAA Critical Center

- Health Care Reform

- HIPAA 5010

- 835 Electronic Remittance

- Certified Vendors

- Enrollment and Agreements

- Resources



Provider News

- Current News

- BlueNews

- News Archives



The Education Center provides resources and tools.

BlueChoice HealthPlan


The Forms section provides information about our various forms, including credentialing and appeals forms.



The Provider Resources section provides tools you can use to work with us more effectively.



Doctor and Hospital Finder

Members and providers can use the Doctor and Hospital Finder to:

– Verify network access for Blue Plans nationwide

– Help determine whether you are in network for a particular member’s plan no matter which Blue Plan you participate with or which Blue Plan holds the member’s health plan


Get the most out of your search!




How to Determine if You are a Network Provider


Access eligibility and benefits, submit precertification requests, view claims status, and much, much more!

My Insurance Manager


Register for My Insurance Manager



Each person in the facility can register under the same Tax ID, however, each person should

create his or her own username, password and complete other

registration information.



Once you create and approve a profile, sign in to My

Insurance Manager using the username and password you

created.



Patient Care

• View claim status

• Check eligibility and benefits

• File a professional or institutional claim

• Create a patient directory

• Check pre-certification



With the patient care option, you have access

to health and dental.



Office Management (Health)

• Review electronic data interchange (EDI) reports

• Add or update electronic funds transfer (EFT) information

• Analyze remittances



The EDI Reports option lets you review electronic claims

you submit via the electronic gateway.



The EFT and ERA Enrollment option lets you submit a request to receive

your reimbursements and remittances electronically.




The Remittance Information option lets you view BlueCross, State Health

Plan, BlueChoice® and Federal Employee Program remittances

stored by the dates we create them.


Resources

• Get answers to frequently asked questions

• Access forms

• Respond to patient reviews

• Obtain the State Health Plan fee schedule



Modify Profile

• Modify security question

• Update username

• Reset password



The Modify Profile options allow profile administrators

or office staff users to update their existing

profiles.



Profile Administration

• Transition from office staff to profile administrator

• Manage the profiles of office staff

• Reset passwords

• Deactivate profiles



Staff Directory

• View office staff who have My Insurance Manager profiles

• Review profile administrator(s) for your facility

• See profiles under your Tax ID



The Staff Directory option shows staff

members registered for My Insurance Manager.



Ask Provider Services

Two Options:

1. Submit your question online via Ask Provider Services and receive response within 24–48 hours

2. Talk to Provider Services online



• Review electronic remittances in a HIPAA-compliant format

• Search remittances by patient, account number or check number

• Available to providers who receive payments electronically

My Remit Manager


My Remit Manager


Select the “ERA” tab to

view check and remit

information.

My Remit Manager


This menu lets you select how you want to order the patients

on your remit. After selecting a check, you can

choose to order the patients by name, account, provider

then name, or provider then

account.

My Remit Manager


After selecting a check and the order criteria,

select “Download ERA” to view the

remit. It will prompt you to

open or save the file as an Adobe

PDF file.

My Remit Manager


These remits are Adobe PDFs and are electronically

transmitted. They are HIPAA-compliant and will

not contain the same remit reason codes that

appear on our paper remits available through My Insurance Manager.

My Remit Manager


When searching for a specific check, you can enter the check

number into the “Search For” field.

When there is information in this

field, it will only display information matching the search

criteria.

My Remit Manager


When you check the “Hide

Reconciled” box, any checks you have marked as reconciled (by checking the

radio box in the RECO column

next to the check) will be

hidden. To display all checks, uncheck this box.

My Remit Manager


The “Payer” menu lets you sort

checks by payer. It will only display checks from the payer you select.

My Remit Manager


The “Provider” menu let you sort

checks by provider. It will only display checks from the

provider you select. This is useful for providers who

manage multiple locations.

My Remit Manager


Under the ERA tab, select “Patients” to

search for a specific patient’s

remit.

My Remit Manager


Enter your search criteria in the

“Search for” field. When searching for a patient using his or her first and last name, be sure to

enter the information in the Last Name, First Name format.

My Remit Manager


You can filter your search results by date of service or check date by

using the “Filter on” and “From Date/To

Date” menu.

My Remit Manager


The “Payer” menu lets you sort the

patient results by payer. It will only

display remits from the payer you

select.

My Remit Manager


The “Status” menu allows you to sort the

patient results by claim status. You can select denied, processed as primary, processed as secondary or reversal of previous payment.


The “Provider" menu lets you sort your results by provider. It will only

display patients from the provider you select. This is useful for providers who

manage multiple locations.

My Remit Manager


ERA Patient Per Page

Allows you to view each patient result on a separate

page

ERA Patient Listing

Displays multiple patients on one page just like traditional

remits

ERA Patient Summary

Displays payment information only without reason codes

ERA Text

Exports remit information into a text file instead of a

PDF

Export Selected ERA Per Page

Exports only the patients that you have checked

Unselect All

Allows you to unselect all patients you have checked

These links let you decide how to view the patient remits once you have narrowed down the patient criteria.

My Remit Manager


Under the ERA tab, select “Reports” to

view the list of report options.

My Remit Manager


The report opens in a new window.

This report shows the denial codes that appear

on your remits, the verbiage for the codes,

the number of times that code appears and

the dollar amount denied as a result of the

code.

My Remit Manager


Enter the date range for your report, then select “Submit New Report”.

Reports may take a moment to generate, so

select the “Check For Finished Reports” link

next.

My Remit Manager


The report opens in a new window.

This report shows the amounts paid by various lines of

business at BlueCross.

My Remit Manager


Select a date on the calendar to

view the EDI report for claims you submitted

that day.

My Remit Manager


Under the Claims tab,

select Legacy Errors, then

select a date on the calendar to view the report for claims you

submitted with errors that day.

My Remit Manager


After selecting an account, you can add a user by selecting “Add User,” edit its information by selecting “Edit User”, reset a password by selecting

“Reset Password” or delete the user by selecting “Delete User”.

My Remit Manager


Enter information into the search box to find a

specific user.

My Remit Manager


This is the page that allows you to create or edit

a user.

My Remit Manager


Select the “Password” tab to change your password. We require you to enter your old password before you can change it.

If you have forgotten your password, you can contact Provider Education to have us reset your password.

First.Last

My Remit Manager


For access to My Remit Manager, please email [email protected] or call

803-264-4730.

My Remit Manager



Inquiry Contact

Problems submitting claims electronically

EDI [email protected]

Enroll practice or billing services as a recipient of electronic data

Electronic Data Interchange Gateway (EDIG) [email protected]

Receive EFT and ERA Provider EFT [email protected]

Reset password for encrypted emails, problems with StatChat functionality

Technology Support Center 855-229-5720

Technical problems with My Insurance Manager

Web Technology Support Center 800-868-2505

Additional Resources



Name Website

BlueChoice HealthPlan Medicaid www.BlueChoiceSCMedicaid.com

Federal Employee Program www.FEPBlue.org

State HealthPlan www.StateSC.SouthCarolinaBlues.com

Companion Benefits Alternatives (CBA) www.CompanionBenefitsAlternatives.com

National Doctor and Hospital Finder www.BCBS.com


http://www.bluechoicescmedicaid.com/

http://www.fepblue.org/

http://www.statesc.southcarolinablues.com/

http://www.companionbenefitsalternatives.com/

http://www.bcbs.com/


Line of Business Provider Services

Voice Response Unit (VRU)

Preferred Blue® and BlueEssentialsSM

For claims status, eligibility and benefits 800-868-2510 (Outside of Columbia) 800-334-2583 (Columbia Area Only)

Out-of-State (BlueCard)

For claims status and inquiries 800-868-2510 (Outside of Columbia) 800-334-2583 (Columbia Area Only) For benefits and eligibility 800-676-BLUE (2583)

Federal Employee Program 888-930-2345 (Toll Free) 803-788-0222 ext. 48800

State Health Plan 800-444-4311 (Toll Free)

BlueChoice HealthPlan and Blue OptionSM 800-868-2528



Provider Relations and Education Team

Name Telephone Email

Jada Addison 803-264-2724 [email protected]

Bunny Temple 803-264-1701 [email protected]

Jamie Self 803-264-2802 [email protected]

Shamia Gadsden 803-264-6966 [email protected]

Ashlie Graves 803-264-4301 [email protected]

Mary Ann Shipley 803-264-3724 [email protected]

Sandy Sullivan 803-264-5969 [email protected]

Contessa Struckman 803-264-3481 [email protected]

Sharman Williams 803-264-8425 [email protected]









mailto:noreen.o'[email protected]



We appreciate our provider community and business partners for working together

to improve the lives of our members.
