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Saturday, May 18, 2024, 2:26 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions

On a hospital claim, if the pay-to provider has revalidated, but the line provider fails to revalidate, will the claim deny?

If MMIS validates the NPI of the rendering physician, then the claim will deny if the individual has not revalidated. Revalidation FAQs PDF

I am a provider with multiple NPIs attached to my Medicaid ID. I completed the provider revalidation application for my primary NPI. Why are my claims being rejected?

Within 30 days from the date on the revalidation notification letter, all other NPIs attached to your Medicaid ID will need to complete an electronic provider enrollment application. To access the online provider enrollment application, copy and paste https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/ into your browser. If you did not complete an electronic provider enrollment application for all non-primary NPIs associated with your Medicaid ID and you wish to continue billing with those NPIs, claims for those NPIs will be rejected. You may resubmit claims once you have received confirmation that the electronic provider enrollment application is complete. Revalidation FAQs PDF

Edit 150

See how to resolve edit code 150 at Frequently Addressed Edit Codes.

Edit 953

See how to resolve edit code 953 at Frequently Addressed Edit Codes.

Edit 989

See how to resolve edit code 989 at Frequently Addressed Edit Codes.

Edit 990

See how to resolve edit code 990 at Frequently Addressed Edit Codes.