CommercialAdministrativeHigh impact
Reminder: High Dollar Pre-payment Review Process
BlueCross BlueShield of South Carolina·SC·Claims
Effective date
Mar 3, 2026
We identified it
Jun 20, 2026
Summary
BlueCross BlueShield of South Carolina requires hospitals to submit detailed itemized bills for high-dollar inpatient claims ($100,000+ for most plans, $75,000+ for Group/Individual plans) through their pre-payment review process. The itemized bills must include specific descriptions, medication names/doses, supply names, CPT/HCPCS codes, and revenue codes for each line item.
Action Required
Immediately: Billing team must ensure all inpatient institutional claims with allowed amounts of $100,000+ (or $75,000+ for Group/Individual BCBS SC plans) include detailed itemized bills when submitted through My Insurance Manager. Each line must contain clear descriptions including medication names/doses, supply names, applicable CPT/HCPCS codes, and revenue codes. Update billing workflows to identify these high-dollar claims and flag them for itemized bill requirements. Failure to provide proper itemized bills will cause payment delays.