BlueCross BlueShield of SC-Corrective Action Plan to Address Non-compliance



This bulletin is to notify all service providers that, effective immediately, the South Carolina Department of Health and Human Services (SCDHHS) has placed BlueCross BlueShield of South Carolina (BCBSSC) Third Party Liability (TPL) Services on notice that a Corrective Action Plan (CAP) is required in accordance with the third party liability SCDHHS contract.

This CAP is necessary in order for BCBSSC to correct the deficiencies identified in the Benefit Recovery, Cash Receipts and Accounting area of the TPL Services Contract.  Specifically, BCBSSC TPL Services has deleted sessions from the Benefit Recovery Tool without an audit trail and proper posting, erroneously indexed and classified checks, and mistakenly created multiple receipt numbers on individual units of work.  BCBSSC’s management failed to identify these deficiencies until brought to their attention by SCDHHS in August 2012. 

This information is provided to ensure contract transparency and SCDHHS will publicly announce all CAPS.  In the event SCDHHS or its designee finds that a contractor and/or its subcontractors failed to comply with requirements of this contract, the contractor may be required to submit a CAP to SCDHHS outlining the steps it will take to correct any deficiencies and/or non-compliance issues identified by SCDHHS in the Notice of Corrective Action.

Contractors under a CAP are required to produce a plan that not only addresses the issues identified, but outlines steps necessary to sustain the corrections.  SCDHHS welcomes public comment regarding the CAP by visiting

Please refer any questions or concerns regarding this bulletin to the SCDHHS Provider Call Center at 1-888-289-0709.  Thank you for your continued support in the South Carolina Medicaid program.

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