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BlueChoice HealthPlan of South Carolina, Inc. fax number
(803) 264-0253
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Privacy Official
Used for: Submission of Authorization to Disclose Protected Health Information (PHI) to a third party; PHI disclosure authorization
Fax destination details
- Department
- Privacy Official
- Purpose
- Submission of Authorization to Disclose Protected Health Information (PHI) to a third party; PHI disclosure authorization
- Form
- Authorization to Disclose Protected Health Information to a Third Party — AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION TO A THIRD PARTY
- Address
- BlueChoice HealthPlan of South Carolina, Inc., Attn: Privacy Official (AX-400), PO Box 6170, Columbia, SC 29260-6170
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Fill out member information (name, date of birth, address, member ID), specify recipient, scope of disclosure, purpose, expiration, and signatures. Return to BlueChoice HealthPlan of South Carolina, Inc., Attn: Privacy Official (AX-400). Fax to 803-264-0253. Mail to PO Box 6170, Columbia, SC 29260-6170.
Official form instructions are published as a downloadable file on the organization's website.
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