Electronic Data Interchange (EDI)

Electronic claims are processed faster and more accurately than those received by mail. SCDHHS will provide an electronic response indicating that we have received your file and which were rejected and why.

Providers can assist SCDHHS in resolving outstanding issues in a timely manner by following the steps below:

1. Contact the SCDHHS Provider Support Center at (888)289-0709 and via email at  edig.ops-mcaid@bcbssc.com. This support team specializes in issues related to EDI claims submittal and processing. Contacting this team will ensure that provider issues are tracked and resolved.
2. Be prepared to provide the following information, as it will assist SCDHHS in resolving the issue:
   • Description of the problem
   • Name of clearinghouse
   • Submitter ID
   • Filename
   • Date and time of file submission
   • Billing NPI

Also please remember these important changes:

1. The 4010 mailbox structure is no longer valid. SCDHHS is actively contacting clearinghouses and trading partners (providers) that appear to be attempting to transmit files into the incorrect folders in the EDI system. This issue has caused delays in claims not being processed and paid. The 4010 mailboxes were disabled completely on January 29, 2012.
2. Web Tool users must have their own login to the SCDHHS provider management tools to submit, view and manage claims. SCDHHS has worked through the backlog in creating new logins, if you still need additional logins please contact the Provider Support Center.

HIPAA 5010 Companion Guides

HIPAA 5010 - Effective January 1, 2013

• 270/271 Eligibility Verification Request/Response
• 276/277 Health Care Claim Status Request and Response
• 820 Premium Payment
• 835 Health Care Claim Payment/Advice
• 837D Health Care Claim (Dental)
• 837I Health Care Claim (Institutional)
• 837P Health Care Claim (Professional)
• NCPDP Post Adjudication Companion Guide

SC Medicaid Trading Partner Enrollment

• Trading Partner Agreement July 19, 2013
• Trading Partner Agreement Enrollment Form January 1, 2014
• Instructions for Providers January 1, 2014
• Trading Partner Agreement Enrollment Form for Vendors and Clearinghouses
• Instructions for Vendors and Clearinghouses January 1, 2014
• Approved Vendor List

Questions

5010 Inquiries and Testing

Contact: EDI Support 

Hours: 7:30 a.m. to 5 p.m. Monday through Thursday, and 8:30 a.m. to 5 p.m. on Friday.

Phone: 1-888-289-0709

Email: edig.ops-mcaid@bcbssc.com