642 Edit Claims Update; Partial Solution Implemented

PROVIDER ALERT

The technical issue causing a 642 edit error in the claims processing system is corrected. However, previously submitted claims cannot be automatically reprocessed. Hospital outpatient claims that rejected due to the 642 edit must be resubmitted. The South Carolina Department of Health and Human Services (SCDHHS) apologizes for any inconvenience.

Approximately 10% of the affected claims are experiencing a secondary issue related to line level entry of coinsurance/deductible information. SCDHHS is working to resolve this problem. In the meantime, if your claims continue to experience the 642 edit, you may be able to bypass the edit by entering the coinsurance/deductible information at the claim level only. SCDHHS will alert hospitals when the solution is implemented for the final 10%. If you continue to experience denials related to the 642 edit, please contact the Provider Service Center at (888) 289-0709 and reference issue code PS272.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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