COVID-19: High Dollar Pre-payment Reviews (HDPR)

Feb. 10, 2021

Due to the COVID-19 pandemic, BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan altered the auditing process of high dollar claims by completing them on a post-payment basis from April 10, 2020 to Oct. 31, 2020.  During this time, high dollar claims in the amount of $200,000.00 were reviewed on a post-payment basis and itemized bills were required.

On Nov. 1, 2020, both plans reverted back to processing high dollar claims in the amount of $200,000.00 or more on a pre-payment review basis.  

Beginning Jan. 1, 2021, the dollar amount for high dollar claims reviews was reduced to $100,000.00.  For you, this means that claims with the allowable charges of $100,000.00 or more will follow the normal pre-payment review process.

All high dollar pre-payment claims reviews require itemized bills.  Submit itemized bills, when requested, via My Insurance Manager℠ (MIM) using the claims attachment feature.  MIM can be accessed through www.BlueChoiceSC.com.

Note: If medical records are needed, you will receive a separate request that will provide instructions on how to submit.

If you have any questions regarding the information in this bulletin, contact Provider Education by using the Provider Education Contact Form located on www.BlueChoiceSC.com.