Intro

(Basketball game sounds; then back in the locker room)

Check online remit

Coach: Let’s talk about best practices for claim filing. Save office time; get the claim to process quicker. Okay, you haven’t gotten paid on a Medicaid claim for a while now. What do you do?

Player: I call up the Provider Service Center.

Coach: That’s great, and they can help you. But did you know that it may be quicker to just check online? Check your remit online on the Web Tool. Sometimes you see other claims that might have problems as well, not just the ones you're asking the customer service center about.

Check Edit Codes

(Basketball game sounds)

Coach: So how can your online remit help you?

Player: I can see whether the claim paid or denied.

Coach: Exactly. And more than that, look for the Edit Codes. If you don’t know why the claim denied, those three-digit numbers are the key to finding out.

Use Provider Manuals

(Basketball game sounds)

Coach: So, how do you use the Edit Codes to resolve your claim?

Player: I could call the Provider Service Center and find out. Or maybe there’s a resource online?

(hoop shot sound)

Coach: Now you’re talking. If you’re already online, take one more step and go to the South Carolina Department of Health and Human Services Web site. That’s www.SCDHHS.gov. Go to the Provider Manuals, find your specialty, and open what’s called: Appendix One. Appendix One has a list of all the edit codes, what they mean, and the steps to resolve your claim.

Consider the Web Tool

(Basketball game sounds)

Coach: So, once you know what to do, what’s the fastest way to get your claim re-submitted?

Player: Well, I used to just redo the claim and mail it hardcopy.

Coach: Exactly! But if you want to add some speed - and if you’re a Web Tool user – you can do this: Copy your denied claim from the Web Tool as a new claim, make the correction, and then re-submit it electronically through the Web Tool.

Recap

(Basketball game sounds)

Coach: So what did you learn?

Player: How to get my claim denial answers online. I go to the Web Tool for my remit, find any denials and associated edit codes, and then look up the edit codes on Appendix One to see how to resolve it, if it’s not obvious. Then, one quick way to re-submit claims is to use the Web Tool to copy the denied claim and resubmit it with my changes.

Coach: That’s it! This approach should save you significant office time and claim processing time.

(Basketball game sounds)

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