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South Carolina Healthy Connections

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Electronic Claim Payment Reconsideration

January 28, 2019

Currently, providers can submit claim payment reconsiderations verbally, in writing or electronically. We are reaching out to notify you about some exciting new tools for electronic submission that will become available through the Availity Portal. Availity is an independent company that administers the secure provider portal on behalf of BlueChoice HealthPlan.

You should soon see changes in the provider manual that will outline this new information regarding claim remediation tools through the Availity Portal.

Beginning March 7, 2019, providers will have the ability to submit claim reconsideration requests through the Availity Portal with more robust functionality. For you, this means an enhanced experience when:

  • Filing a claim payment reconsideration.
  • Sending supporting documentation.
  • Checking the status of your claim payment reconsideration.
  • Viewing your claim payment reconsideration history.

New Availity Portal functionality will include:

  • Acknowledgement of submission at the time of submission.
  • Notification when a reconsideration has been finalized by Healthy Blue
  • A worklist of open submissions to check a reconsideration status.

With the new electronic functionality, when a claim payment reconsideration is submitted through the Availity Portal, we will investigate the request and communicate an outcome through the Availity Portal. Once an outcome has been determined, the Availity Portal user who submitted the claims payment reconsideration will receive notification informing him/her that the reconsideration review has been completed. If you are not satisfied with the reconsideration outcome, continue to follow the existing process to file an appeal, as outlined in your provider manual.

Look for announcements on the Availity Portal for upcoming training opportunities. Providers who have questions as they begin to use the new functionality should contact our Customer Care Center at 866-757-8286.

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