Services Claims Payments for January 6, 2012

The South Carolina Department of Health and Human Services (SCDHHS) has received inquiries regarding an unusually high number of suspended claims that appear on the January 6, 2012 Remittance Advice (RA).

These suspended claims were due to the National Correct Coding Initiative (NCCI) Edit Review. During a weekly payment cycle, these claims are processed and sent in a daily file to Health Management Systems, Inc. (HMS) to perform NCCI edits for services subject to the Centers for Medicare and Medicaid Services (CMS) NCCI guidelines. In order to finalize all of the 4010 processing prior to 12/31/2011, the January 6, 2012 payment was run early which captured many claims still in process for NCCI Edit review. The claims that appear with suspend status and are related to NCCI edits on your January 6, 2012 RA have already been cleared and will be processed in next week’s payment dated 1/13/2012.

We sincerely apologize for the inconvenience. Our goal is to ensure claims are processed in a timely manner. For more information on the NCCI edits you may refer to the previously issued Medicaid Bulletin dated August 25, 2011.

The link is:
(http://www.scdhhs.gov/Internet/pdf/NCCIbulletinAugust2011.pdf).

Please contact the Provider Service Center (PSC) at 888-289-0709 with any further concerns. Thank you for your understanding.

Report Fraud