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

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.
Entry link: What do you do if a beneficiary is out of visit counts?

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

What is the payment cycle?

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

Entry link: What is the payment cycle?

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

Correct and refile that one line.
Entry link: What should I do if one line does not pay on your claim?

When would you use a void?

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

Entry link: When would you use a void?

Where are your procedure codes located?

Procedure codes are located in Section 4 of your manual and the DHHS website.
Entry link: Where are your procedure codes located?

Where can carrier codes be located?

Carrier Codes can be located in Appendix 2 of the Provider Manual.
Entry link: Where can carrier codes be located?

Where can you find an out of state referral form?

That form can be found on SCDHHS.gov.

Entry link: Where can you find an out of state referral form?

Where do you get the bulletins?

You can sign up for e-bulletin on the SCDHHS.gov page.
Entry link: Where do you get the bulletins?


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