south carolina medicaid coordination of benefits place client logo here

South Carolina Medicaid Coordination of Benefits

Place Client Logo here

General Info

Providers must bill all other insurance carriers before billing SC Medicaid

If payment is received from multiple payer sources, Medicaid requires Total Amount Paid in “Other Payer Amount Paid” field

Magellan Medicaid Administration | 2

SC Medicaid is Always Payer of Last Resort

Magellan Medicaid Administration | 3

Compliance is Key

If a primary carrier requires a PA, the primary carrier’s prior authorization procedures must be followed

Magellan Medicaid Administration | 4

Fields Required in Processing Medicaid Secondary Claims

Other Coverage Code (OCC)

(NCPDP field # 3Ø8-C8) Other Payer Date

(NCPDP field # 443-E8) ID Qualifier =“99”

(NCPDP field # 339-6C) Other Payer ID

(NCPDP field # 34Ø-7C)

Magellan Medicaid Administration | 5

Other Coverage Codes(NCPDP field # 3Ø8-C8)

Other Coverage Codes (NCPDP field # 3Ø8-C8)

Enter OCC of 2 if payment was received from primary insurer Enter primary insurer payment amount in the “Other Payer Amount Paid”

field (NCPDP 431-DV)

Effective September 15th, 2010 providers must populate patient’s copayment in the “Patient Paid Amount Submitted” field (NCPDP 433-DX)

Enter OCC of 3 if a particular drug is not covered by an individual’s active primary/secondary coverage Effective September 15th, 2010 the reject code after billing the primary

insurer should be populated in the “Other Payer Reject Code” field (NCPDP 472-E)

Magellan Medicaid Administration | 7

Other Coverage Codes (NCPDP field # 3Ø8-C8)

Enter OCC of 4 if instructed to collect money from patient for not meeting deductible or co-pay with active primary insurance (No changes for the OCC of 4)

Enter OCC of 7 if verified by insurance carrier that beneficiary has no other coverage on date of service Effective September 15th, 2010 the reject code after billing the primary

insurer should be populated in the “Other Payer Reject Code” field (NCPDP 472-E)

Magellan Medicaid Administration | 8

Other Payer ID(NCPDP field # 34Ø-7C)

Insurance Carrier Codes

http://southcarolina.fhsc.com/providers/rxdocuments.asp

Magellan Medicaid Administration | 10

Click one of the links

to access Insurance

Carrier Codes to

enter in the “Other

Payer ID” field

Don’t Forget!

Do not use a 1, 5, 6, or 8 in the OCC Field-(claim will reject) Medicaid does not coordinate benefits with Medicare Part D or with a

beneficiary’s creditable coverage

Magellan Medicaid Administration | 11

Magellan Medicaid Administration | 12

Required on ALL COB claims

Field Name NCPCP field #

Other Coverage Code (OCC) 3Ø8-C8

Other Payer Date 443-E8

ID Qualifier 339-6C

Other Payer ID 34Ø-7C

Required on ALL OCC= 2 claims

Field Name NCPDP field #

Other Payer Amount Paid 431-DV

Patient Paid Amount Submitted 433-DX

Required on ALL OCC= 3 claims

Field Name NCPDP field #

Other Payer Reject Code 472-6E

Required on ALL OCC= 4 claims

Field Name NCPDP field #

No additional fields required N/A

Required on ALL OCC= 7 claims

Field Name NCPDP field #

Other Payer Reject Code 472-6E

Contacts

Magellan Medicaid Administration SCProvidersupport@magellanhealth.com

SCDHHS Janet Giles

Gilesje@scdhhs.gov

Brandie Crider

Criderb@scdhhs.gov

Phone: 803-898-2876

Magellan Medicaid Administration | 13