BlueChoice HealthPlan is an independent licensee of the Blue Cross Blue Shield Association. Copyright 2023 BlueChoice HealthPlan. Since 2010, HealthMarkets has helped enroll Americans in more than 4 million insurance policies. The company sells What Other Resources are Available to Assist Me in Learning More About Avalon? WebBlueChoice HealthPlan is a wholly-owned subsidiary of Blue Cross and Blue Shield of South Carolina. Contact your tax or legal professional to discuss details regarding your individual business circumstances. You can send prior authorization requests to Avalon by completing the Preauthorization Request Form, by calling 844-227-5769 or by faxing 888-791-2181. Review the specific procedures in the utilization matrix. Enrollment in any plan depends on contract renewal. Access your digital ID card, check claims status, view plan details and check your benefits. View the Cardiac Services Checklist and Cardiac Services Tip Sheet to learn more about prior authorization requirements. Service and product availability varies by state. BlueChoice HealthPlan is an independent licensee of the Blue Cross Blue Shield Association. This information is not a complete description of benefits. To find out which medical specialty drugs require prior authorization under the Specialty Medical Benefit Management (SMBM) program, view the Medical Drug List. Today it serves around 200,000 people. WebWith BlueChoice HMO Open Access-High Option, your primary care provider (PCP) provides routine care and coordinates specialty care. Key plan changes. Drugs with a site-of-care requirement may only be approved in certain sites of care or if the patient is under 18 years of age. You can still enroll for coverage if you have a qualifying life event that gives you a Special Enrollment Period. There are some exceptions. Learn about qualifying eventsto see if you qualify. Note: Some infused specialty medications commonly administered in the hospital setting can be safely provided at home, in a physicians office or in an infusion suite. WebChoice by Select Health of South Carolina Humana Healthy Horizons@ in South Carolina Healthy Blue BlueChoice@ HealthPlan of SC Please check this page frequently for new information. BlueChoice HealthPlan is a health maintenance organization in South Carolina and an independent licensee of the Blue Cross and Blue Shield Association. BlueChoice Health Plan was founded in 1984 and was the first HMO plan offered by BlueCross Blue Shield of South Carolina, sold under the name Companion HealthCare. It is a part of the BlueCross BlueShield group rating of A+ received by A.M. Best Company. BlueChoice HealthPlan is an independent licensee of the Blue Cross Blue Shield Association. Copyright 2023 BlueChoice HealthPlan. WebLaboratory Prior Authorization. Web2023 Blue Option SM. Explore BlueChoice HealthPlan with HealthMarkets today! BlueChoice HealthPlan is an independent licensee of the Blue Cross Blue Shield Association. Use the "Ask Customer Service" feature to send a confidential email to the right person to help you. Precertification and Referral Guide Learn how to submit a referral or precertification request through My Insurance ManagerSM and determine which services we can automatically authorize. Please call us toll free at 866-280-0766 or in Columbia at 803-382-5976. Box 6170 Oxygen and respiratory equipment Health care is complicated. Do you need information about or want to enroll in our Great Expectations for health programs? PAYER ID PAYER NAME ENROLLMENT REQUIRED - ABILITY Note that with this new program, certain lab procedures when performed in an office, outpatient or independent lab location will require prior authorization. You can also call us at 800-868-2528 8:30 a.m. until 5 p.m. Eastern Time, Monday through Fridayor write us at: This program will assist us in ensuring appropriate testing for our members at the lowest out-of-pocket cost. 2023 HealthMarkets Insurance Agency. Blue365 gives you access to exclusive health and wellness discounts. Columbia, SC WebBlueChoice HealthPlan offers Blue Option to individuals and families seeking health coverage in South Carolina. My Health Toolkit Access your digital ID card, check claims status, view plan Durable Medical Equipment (DME) Non-Discrimination Statement and Foreign Language Access, Your Rights and Protections Against Surprise Medical Bills. WebBlueChoice HealthPlan of South Carolina. Find your answers online in My Insurance ManagerSM! BlueChoice HMO Open Access-High Option - CareFirst WebYou can call us at 800-868-2528 8:30 a.m. until 5 p.m. BlueChoice HealthPlan Kaiser Family Foundation (2019). To find providers in our individual Blue Option network, please visit www.BlueOptionSC.com. Effective January 1, 2016, BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina require Avalon Healthcare Prior Authorization Request for Ancillary Services Form. Individual & Family Health Insurance Plans in Maryland - CareFirst This precertification requirement is only applicable to BlueCross and BlueChoice Exchange members receiving nuclear cardiology services. You will be required to provide proper documentation before your coverage becomes effective. (These links lead to third party sites. The company sells health insurance to individuals and families and has around 31 different plans through the Blue Option that includes bronze, silver, gold, and catastrophic coverage. What Physicians Need to Know About Avalon Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Attention: This website is operated by HealthMarkets Insurance Agency and is not the Health Insurance Marketplace website. We also require prior authorization for lumbar and cervical spine surgery in an inpatient and/or outpatient location. WebServing Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group January 1, 2016, we introduced a program that will improve the quality and reduce the cost of laboratory services our members receive. Box 6170. Additionally, some member benefit plans may be exempt. WebA proprietary health plan-specific indication of the type of provider being enrolled for EFT with spe-cific provider type description included by the health plan in its instruction and Not all agents are licensed to sell all products. ET, Monday through Friday. The Medical Form Resource Center (MFRC) is an online tool created to allow you to submit your precertification requests for some services electronically. P.O. WebExplore tools to estimate and compare costs. We are dedicated to ensuring your patients receive the highest quality laboratory testing at the most reasonable cost. Please note that Avalon doesn't manage services in an emergency room or hospital inpatient setting. Whether you know what coverage you need or want to explore your options, CareFirst offers a range of Member & Guest Services We can only accomplish this if we effectively manage the network of laboratory providers and if your practice accesses the laboratories that have been accredited for participation in the health plan. My Insurance Manager also has an "Ask Provider Services" feature, where you can send a secure message directly to our Provider Services department. Refer to the BlueChoice Radiology Utilization Matrix for specific procedures that require authorization. Call the Plans customer service phone number for more information. No obligation to enroll. View a comprehensive list of the independent laboratories that are in-network. BlueChoice HealthPlan. To ensure the lowest cost to your patients, please send BlueCross and BlueChoice members testing to in-network laboratories only. Blue365 gives you exclusive access to health information and more! (If it's your first time, you'll have to create a simple profile first.) Avalon has developed a Lab Procedure Authorization matrix in an effort to help you determine when you need to contact Avalon for prior authorization. Blue Choice Content - Get a Quote HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. If an out-of-network laboratory services you or you have outpatient testing performed by a hospital, your patients out-of-pocket cost may be significant. About Us | BlueChoice HealthPlan of South Carolina BlueChoice HealthPlan is an independent licensee of the Blue Cross Blue Shield Association. Your Rights & Protections Against Surprise Medical Bills, Non-Discrimination Statement and Foreign Language Access. MSK Group Prefixes Requiring NIA MSK Precertification, MSK Interventional Pain Management Checklist, MSK Interventional Pain Management Frequently Asked Questions, MSK Quick Reference Guide for Order Physicians/Surgeons, MSK Spine Surgeries Frequently Asked Questions, RadMD Pain Management Injection Quick Start Guide, RadMD Pain Management Surgery Quick Start Guide, Radiation Oncology Frequently Asked Questions (FAQ), Radiation Oncology Solutions Presentation, Radiation Therapy Treatment Notification Form, Avalon Claim Editor Frequently Asked Questions, Non-Discrimination Statement and Foreign Language Access, Your Rights and Protections Against Surprise Medical Bills. The Blue Cross and Blue Shield Names and Symbols are registered trademarks of the Blue Cross and Blue Shield Association. We've put together some information to better serve you when requesting prior authorization. WebAbout BlueChoice HealthPlan From the mountains to the Midlands, across the state and down the coast, BlueChoice HealthPlan is truly South Carolina's health plan. Ancillary Services BlueChoiceHealthPlan directly manages prior authorizations, claims and network management processes for ancillary services, including: ET, Monday through Friday. Thats why its important to review whether the use of these medications meets coverage criteria before a specialty drug is provided. Let us help you understand the many options available so you can make the best choice. WebMy Health Toolkit. Plus, spending account resources that offer flexibility. NIA Magellan is an independent company that provides utilization management services on behalf of BlueChoice HealthPlan. With BlueChoice HMO Open Access-High Option, your primary care provider (PCP) provides routine care and coordinates specialty care. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces. Hemophilia management iy_2023; im_07; id_01; ih_00; imh_21; i_epoch:1.68819609332E+12, py_2023; pm_06; pd_08; ph_10; pmh_00; p_epoch:1.68624363537E+12, link-block; link-block_link-block; bodystr, pn_tstr:Thu Jun 08 10:00:35 PST 2023; pn_epoch:1.68624363537E+12, https://www.healthmarkets.com/company/blue-choice-health-plan/. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1- 877-486-2048) 24 hours a day/ 7 days a week to get information on all of your options. Do you have a question about your own personal claims, eligibility or benefits? CareCore National Web Portal RadMD, one of the services NIA provides, allows contracting health care providers to enter authorization requests via the internet. All rights reserved. | BlueChoice HealthPlan of South Carolina They can be costly for our members, and not all plans cover them the same way. This plan allows members to visit specialists directly without referrals. With the My Health Toolkit app, you can: Find a doctor or hospital in your network. Our quoting tool is provided for your information only. Visit with a doctor anytime, anywhere with Blue CareOnDemand. WebBlueChoice HealthPlan is a health maintenance organization in South Carolina and an independent licensee of the Blue Cross and Blue Shield Association. It provides very low-cost health insurance coverage for individuals and Healthy Connections Medicaid! Find the right care for you across our expansive network of doctors, hospitals and You can also submit requests using the Prior Authorization for Services and Procedures Form. Hear better. BlueChoice HealthPlan is an independent licensee of the Blue Cross Blue Shield Association. Health Tips & Tools. Forgot Username? Hematologists, oncologists, nephrologists and rheumatologists may continue to bill for these drugs under the medical benefit. Feel Magellan manages precertification for advanced radiology, musculoskeletal care, radiation oncology and nuclear cardiology, as well as certain imaging services. BlueCard lets you take your health care coverage wherever you go. Home speech therapy You can also view their radiology policies. All Rights Reserved. Both are Independent Licensees of the Blue Cross and Blue Shield Want information about our Great Expectations for health programs? Home health services There are also high deductible health plans (HDHPs) and flexible spending accounts (FSAs), and health reimbursement accounts (HRAs) for some health plan members. Access your digital ID card, check claims status, view plan details and check your benefits. BlueChoice HealthPlan is an independent licensee of the Blue Cross Blue Shield Association. All quotes are estimates and are not final until consumer is enrolled. Please call us toll free at 866-280-0766 or in Columbia at 803-382-5976. Members may choose to take part in our Away From Home Care program which allows you to take your plan benefits with you if youre in- or out-of-area for at least 90 days. Copyright 2023 BlueChoice HealthPlan. Columbia, SC 29260-6170. Get Healthy with the FOCUSfwd Wellness Incentive Program. Blue Option Get a quote and enroll your clients! All Rights Reserved. Do you have a question about QuickBillSM, QuickEnroll or other general questions about administering your company's BlueChoice HealthPlan coverage? Or write us at: The drugs on the Self-Administered Drug Listmust be billed under the pharmacy benefit. As technology improves, the cost and utilization of these services increase. Here are reference materials about Avalon: BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association. Home occupational therapy WebLearn all the ways you can save, just because you're a BlueChoice HealthPlan member! Member Center | BlueChoice HealthPlan of South Carolina Columbia, SC 29260-6170. Prior Authorization for Services and Procedures Form. BlueChoice HealthPlan Our Use the "Ask Customer Service" feature to send a confidential email to the right person to help you. You can call us at 800-868-2528 8:30 a.m. until 5 p.m. Please select "BlueChoice HealthPlan" followed by the study desired. This change does not alter the available member benefits, but using these participating providers will result in a lower out-of-pocket cost for your BlueCross- and BlueChoice-covered patients. Januar PAYER ID PAYER NAME BlueChoice has considered this issue and has included specialty labs and centers of excellence within the network of laboratory providers. My Health Toolkit Login | BlueCross BlueShield of South Carolina P.O. Other Logins. Effective January 1, 2016, BlueCross BlueShield of South Carolina and BlueChoiceHealthPlan of South Carolinarequire Avalon Healthcare Solutions to precertify certain lab procedures when performed in an office, outpatient or independent lab location. Log in to My Health Toolkit. Specialty medications often are covered under the medical benefit. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. Please use the Prior Authorization Request for Ancillary Services Form. This plan allows members to visit WebBlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association. WebChoosing a health plan for yourselfor your familyis an important decision. Blue Option SC Your favorite features from the website are now available in a mobile app. Payer ID Payer Name Comments - ABILITY Network is an independent licensee of the Blue Cross Blue Shield Association. 10121 BlueChoice HealthPlan South Carolina Medicaid 13554 BlueCross Medicare Advantage 11177 Bluegrass Family Health. You have access to comprehensive services such as after-hours care including 24-hour nurse advice line, video visits, convenience care clinics, and urgent care visits. Here are NIA Magellan Healthcare Inc.s reference materials about this musculoskeletal (MSK) care management program: Beginning January 1, 2015, some groups will require National Imaging Associates (NIA) precertification for radiation oncology services when performed and billed in an outpatient or office location. Laboratory medicine is continuing to become increasingly complex. Sources: Health Spending Account All rights reserved. We understand the unique insurance needs of individuals and families as well as small business owners and their employees. Blue Choice Option is a Medicaid Managed Care program sponsored by New York State. Or write us at: Member & Guest Services. See some of the benefits of being a member of BlueChoice HealthPlan. Average Single Premium per Enrolled Employee For Employer-Based Health Insurance. BlueChoice HealthPlan of South Carolina HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Which Laboratories are In-network? Sales agents may be compensated based on a consumers enrollment in a health plan. The program also includes requirements for self-administered drugs and site-of-care that may impact coverage, which is important to know if you provide these types of medications. Non-Discrimination Statement and Foreign Language Access, Your Rights and Protections Against Surprise Medical Bills, Get connected to BlueChoice HealthPlan faster and easier with the, Stay on track to meet your goals with some help from of our. The cost of health care is rising for everyone and we have an obligation to ensure that our members receive the highest quality of care at the most affordable cost. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association. Any information we provide is limited to those plans we do offer in your area. BlueChoice HealthPlan With thousands of plans to choose from nationwide and personal service at no additional cost to you, HealthMarkets is the smarter way to shop for insurance. Compare affordable BlueChoice HealthPlan health insurance plans and save money. Blue Choice Option | Excellus BlueCross BlueShield Prior Authorization | BlueChoice HealthPlan of South How Do You Contact Avalon? PDFs require Adobe Acrobat Reader to open. BlueChoice HealthPlan Home infusion therapy Orthotics and prosthetics You can also use our Doctor & Hospital Finder to find participating labs. Do you need information about a patient's coverage, eligibility, claims, our network or other provider issues? My Health Toolkit Access your digital ID card, check claims status, view plan Why Did BlueChoice Make This Change? WebBlueChoice HealthPlan is an independent licensee of the Blue Cross Blue Shield Association. Because BlueChoice belongs to Blue Cross Blue Shield of South Carolina, members have access to some of the largest networks in the state. If you have a headset, you can even talk to our provider service representatives online! Copyright 2023, BlueChoice HealthPlan. Sometimes patients may need a specialized test. Here are National Imaging Associates' reference materials about this radiation oncology program: Effective November1, 2016, BlueCross BlueShield of South Carolina and BlueChoiceHealthPlan require precertification for nuclear cardiology services through National Imaging Associates (NIA). All Rights Reserved. We have the plans to fit your health care needs and budget. P.O. Home physical therapy Like many insurance companies, BlueChoice HealthPlans product offerings include the following types of plans: HMO, EPO, and HDHP. CareFirst Member Non-Discrimination Statement and Foreign Language Access. All Rights Reserved. WebBlueChoice HealthPlan is an independent licensee of the Blue Cross Blue Shield Association. Access your digital ID card, check claims status, view plan details and check your benefits. Thosecompaniesare solely responsible for the contents and privacy policies on their sites.). Providers | BlueChoice HealthPlan of South Carolina Access your digital ID card, check claims status, view plan details and check your benefits. Download it free from the Adobe site. BlueChoice HealthPlan is an independent licensee of the Blue Cross Blue Shield Association. Need information about our products, quotes or how to use My Business Manager? Its easy to get a free insurance quote now. Need to request a prior authorizationbut don't know where to start? 2023 Blue Option. You can video chat with a doctor anytime, anywhere through Blue CareOnDemand. We do not qualify all laboratories. Open enrollment has ended. ELECTRONIC FUND TRANSFER ENROLLMENT FORM Member Information | CareFirst BlueCross BlueShield Avalon is an independent company that provides benefit management services on behalf of BlueCross and BlueChoice. Certain self-administered drugs arent covered under the medical benefit. Get rewarded for living a healthy lifestyle with the FOCUSfwd Wellness Incentive Program. The centers of excellence are staffed by qualified clinical pathologists and genetic counselors prepared to answer your inquiries both before and after you perform testing. Blue Option. With Blue Option, you get more than just a great health plan. Member & Guest Services WebFor log in problems: Please try the email address that you registered with as your user name. Avalon will promptly review your request and provide a timely, written decision. Each of the organizations we represent has a Medicare contract. HealthMarkets Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, PPO and PPFS organizations and stand-alone prescription drug plans. Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueChoice, Inc. and First Care, Inc. are affiliate companies and also offer health benefit products and services on this site. Box 6170 Private duty nursing BlueChoice is simple. There are open access plans through BlueChoice Advantage and BlueChoice Advantage Plus, which allows members to visit doctors and specialists without a referral. Non-Discrimination Statement and Foreign Language Access, Your Rights and Protections Against Surprise Medical Bills. Copyright 2023 BlueChoice HealthPlan. Visit RadMD, the secure webpage of National Imaging Associates (NIA). Agent cannot provide tax or legal advice. Access the user guide here. Note: Prior authorizations for medical specialty drugs have always been a requirement for BlueChoice HealthPlan members. You can submit requests for prior authorizationby fax,phone or the web tool. 10121 BlueChoice HealthPlan South Carolina Medicaid 13554 BlueCross Medicare Advantage 11179 BMC HealthNet Plan 13151 Boon-Chapman Beneit Admin. Forgot Password? CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., First Care, Inc., The Dental Network and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. Brochure. Summaries of benefits and coverage. For a more complete summary of your benefits, please see your 2018 Plan Information Booklet. It was also the first health plan in the state to receive accreditation from the National Committee for Quality Assurance (NCQA). Access your digital ID card, check claims status, view plan details and check your benefits. Find out what member discounts are available to you. Contact | BlueChoice HealthPlan of South Carolina BlueChoice HealthPlan - Insurance from BlueChoice HealthPlan Cost & Comparison Tools. The system is fast and easy to use and ensures accuracy. How Does This Program Affect You? (If it's your first time, you'll have to create a simple profile first.) Our goal is to make the prior authorization process fast, easy and accurate. Log in to My Health Toolkit. Beginning May 1, 2016, some groups will require National Imaging Associates (NIA) Magellan Healthcare Inc. precertification for interventional pain management spine services when performed and billed in an outpatient or office location. Updates usually occur quarterly but can happen at any time. SM. We do not offer every plan available in your area. We make changes to all of our drug lists from time to time. Hospice. Create An Account. Need help with your coverage,claims, eligibility or benefits? Blue Option | BlueChoice HealthPlan of South Carolina