Frequently Asked Questions

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Frequently Asked Questions


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Can we find edit codes on the Web Tool?

No, however the edit code listing is found in Appendix 1 of your provider manual.

If the beneficiary had Champus or Tri-Care and it paid 100%, why would I need to file to Medicaid?

You would need to file to Medicaid for reporting purposes and for seeing the claim through from beginning to end. 

Can the HIIRF form be faxed?

The HIIRF can be faxed to Medicaid Insurance Verification Services at (803) 252-0870.

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.

When is the credit balance report due?

Reports are due by the 30th day of the following month after the respective quarter end. If the report has not been submitted by the due date, a late notification letter will be sent to the provider.

Do I still submit the UB-04 adjustment if I've submitted the credit balance report?

The MIVS credit balance reporting format is not eliminating or replacing a provider’s necessity to submit a UB-04 for claim adjustment(s).

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.

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.

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