Learning Resources
Frequently Asked Questions
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If you make an error and you submit the claim on the Web Tool, is there a way to cancel or make a correction that same day?Once a claim is submitted via the Web Tool, there is no way to cancel or make a correction to the submitted claim that same day. Once the claim has gone through the payment cycle, you will be able to see if the claim has been rejected, paid, or suspended. You will then be able to make corrections to the claim before resubmitting as a new claim. | |
What is a credit balance?A credit balance is a positive amount that remains in a patient’s account which may have resulted from multiple reimbursements from several payers, adjustments to previously paid claims of a provider, duplicate payment, or subrogation events due to accidents and other injury cases. When another third party payer reimburses a provider for claims that Medicaid paid, either in part or in full, a refund is due to the Medicaid Program. | |
How do I know that my credit balance report was received?Providers may send an e-mail request for Medicaid credit balance receipt confirmation to creditbalancemivs@bcbssc.com. For questions call 1-888-289-0709 option 5, option 1. | |
Do I still submit the UB-04 adjustment if I've submitted the credit balance report? | |
Is the credit balance report replacing other credit balance reivews I receive from other agencies?The Medicaid Credit Balance Report is not replacing the current credit balance reviews performed by other reviewing agencies. Providers are not to report other agencies’ identified claims on the Medicaid Credit Balance Report - this may cause possible duplication of claim recoupment. Providers impacted by such reviews need to continue their current procedure in responding to any correspondence received from other agencies’ credit balance reviews. | |
Why was my credit balance report rejected?Providers that submit inaccurate or incomplete information will be notified of the rejected credit balance report. The provider will be instructed to re-submit another report for the applicable quarter. | |
Where do I send in my credit balance report? | |
Who initiated these new screening and enrollment guidelines?The Centers for Medicare and Medicaid Services (CMS), under standards established by the Affordable Care Act (ACA), with a focus on strengthening requirements for Medicaid provider screening and other enrollment requirements. | |
When will the new screening and enrollment guidelines be implemented?Although indicated in a May 9, 2012 Medicaid Bulletin and letter to State Agencies this would be implemented by August 1, 2012, due to delays a new implementation date will be targeted and communicated to providers in future bulletins. Prior to implementation, provider outreach activities will focus on communication of the new policies and other related information. New screening and enrollment information will be distributed through Medicaid bulletins, SCDHHS website messages and alerts, training and orientation activities for certain programs and updates to Program Manuals. | |