Frequently Asked Questions


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Frequently Asked Questions

 

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MED BASICS

If the beneficiary doesn’t have an ID number for the MCO, how do we obtain it?

Contact the MCO.

What do you do if a beneficiary is out of visit counts?

When checking eligibility, you will see what visit counts they have left. You can request more from your representative or treat them as a self pay.

What do you do if you contact a Primary Care Provider and they have no record of a patient?

If this were to happen, you would need to contact the Managed Care Organization directly.

What is the payment cycle?

The payment cycle is: Wed-Mon, payments are processed on Tuesday, and payment is received as early as Friday.

What should I do if one line does not pay on your claim?

Correct and refile that one line.

When would you use a void?

You would use a void if you bill for something by mistake; accidental claim submission, for example.

Where are your procedure codes located?

Procedure codes are located in Section 4 of your manual and the DHHS website.

Where can carrier codes be located?

Carrier Codes can be located in Appendix 2 of the Provider Manual.

Where can you find an out of state referral form?

That form can be found on SCDHHS.gov.

Where do you get the bulletins?

You can sign up for e-bulletin on the SCDHHS.gov page.

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