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Reimbursement Policy Update – Claims Requiring Additional Documentation

October 23, 2018

(Policy 06-031, effective 03/01/19)

Professional providers and facilities are required to submit additional documentation for adjudication of applicable types of claims. If the required documentation is not submitted, the claim may be denied. Healthy Blue may request additional documentation or notify the provider or facility of additional documentation required for claims, subject to contractual obligations.

Effective March 1, 2019, if an itemized bill is requested and/or required, then it must include the appropriate revenue code for each individual charge.

For additional information, please review the Claims Requiring Additional Documentation reimbursement policy by going to www.HealthyBlueSC.com and selecting Providers.

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