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PAGE 1 OF 2 CONTINUED ON PAGE 2 www. BlueChoiceSCMedicaid.com BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association. BlueChoice HealthPlan has contracted with Amerigroup Partnership Plan LLC an independent company for services to support administration of Healthy Connections. Gov. WEBPBSC-0285-17 January 2017 SC Medicaid PAB Fax Form 12. 15. 16. docx 9. PHYSICIAN SIGNATURE Prescriber or authorized signature Date treating physician can determine what...
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