South Carolina Department of Health and Human Services Claims Payments for December 30, 2011

The South Carolina Department of Health and Human Services (SCDHHS) has
determined that payments for CMS1500 claims reflected on the provider
remittance advice dated December 30, 2011, were not processed correctly. The
308 edit (invalid procedure code modifier) was erroneously assigned to claims
due to a system problem.

The problem has been corrected and claims that rejected with a 308
edit have been identified. These rejected claims have been re-cycled
and payment will be reflected in a separate remittance advice (RA)
dated December 31, 2011. Due to the New Year’s banking holiday,
funds (EFT) are expected to be available on Tuesday, January 3, 2012
for most RAs; however, some funds may not be available until
Wednesday, January 4, 2012.

Providers showing claims rejected with the 308 edit on the December
30, 2011 RA could receive two separate RAs dated December 31, 2011.
These RAs are separate, they contain unduplicated claims.
Regenerated 835s reflecting the corrections related to the 308 edit are
available online today.

If you need more information, please contact the SCDHHS Medicaid Provider
Support Center (PSC) at 888-289-0709. The PSC hours are 7:30 AM – 5:00 PM
Monday through Friday. The PSC will be closed on Monday, January 1, 2012 due
to the holiday.

Our staff will continue to monitor claims to identify any other possible errors with
the 308 edit. We sincerely apologize for the inconvenience and are establishing
procedures that will help us identify and resolve these problems more quickly, as
well as prevent them in the future.

Report Fraud