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South Carolina Medicaid Coordination of Benefits Place Client Logo here.

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Presentation on theme: "South Carolina Medicaid Coordination of Benefits Place Client Logo here."— Presentation transcript:

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2 South Carolina Medicaid Coordination of Benefits Place Client Logo here

3 General Info Providers must bill all other insurance carriers before billing SC Medicaid If payment is received from multiple payer sources, Medicaid requires Total Amount Paid in Other Payer Amount Paid field Magellan Medicaid Administration | 2

4 SC Medicaid is Always Payer of Last Resort Magellan Medicaid Administration | 3

5 Compliance is Key If a primary carrier requires a PA, the primary carriers prior authorization procedures must be followed Magellan Medicaid Administration | 4

6 Fields Required in Processing Medicaid Secondary Claims Other Coverage Code (OCC) (NCPDP field # 3Ø8-C8) Other Payer Date (NCPDP field # 443-E8) ID Qualifier =99 (NCPDP field # 339-6C) Other Payer ID (NCPDP field # 34Ø-7C) Magellan Medicaid Administration | 5

7 Other Coverage Codes (NCPDP field # 3Ø8-C8)

8 Other Coverage Codes (NCPDP field # 3Ø8-C8) Enter OCC of 2 if payment was received from primary insurer Enter primary insurer payment amount in the Other Payer Amount Paid field (NCPDP 431-DV) Effective September 15th, 2010 providers must populate patients copayment in the Patient Paid Amount Submitted field (NCPDP 433-DX) Enter OCC of 3 if a particular drug is not covered by an individuals active primary/secondary coverage Effective September 15th, 2010 the reject code after billing the primary insurer should be populated in the Other Payer Reject Code field (NCPDP 472-E) Magellan Medicaid Administration | 7

9 Other Coverage Codes (NCPDP field # 3Ø8-C8) Enter OCC of 4 if instructed to collect money from patient for not meeting deductible or co-pay with active primary insurance (No changes for the OCC of 4) Enter OCC of 7 if verified by insurance carrier that beneficiary has no other coverage on date of service Effective September 15th, 2010 the reject code after billing the primary insurer should be populated in the Other Payer Reject Code field (NCPDP 472-E) Magellan Medicaid Administration | 8

10 Other Payer ID (NCPDP field # 34Ø-7C)

11 Insurance Carrier Codes Magellan Medicaid Administration | 10 Click one of the links to access Insurance Carrier Codes to enter in the Other Payer ID field

12 Dont Forget! Do not use a 1, 5, 6, or 8 in the OCC Field-(claim will reject) Medicaid does not coordinate benefits with Medicare Part D or with a beneficiarys creditable coverage Magellan Medicaid Administration | 11

13 Magellan Medicaid Administration | 12 Required on ALL COB claims Field NameNCPCP field # Other Coverage Code (OCC)3Ø8-C8 Other Payer Date443-E8 ID Qualifier339-6C Other Payer ID34Ø-7C Required on ALL OCC= 2 claims Field NameNCPDP field # Other Payer Amount Paid431-DV Patient Paid Amount Submitted433-DX Required on ALL OCC= 3 claims Field NameNCPDP field # Other Payer Reject Code472-6E Required on ALL OCC= 4 claims Field NameNCPDP field # No additional fields requiredN/A Required on ALL OCC= 7 claims Field NameNCPDP field # Other Payer Reject Code472-6E

14 Contacts Magellan Medicaid Administration SCDHHS Janet Giles Brandie Crider Phone: Magellan Medicaid Administration | 13


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