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@palmettogba.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 that accompanied SCDHHS' 5010 update:

  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 The 4010 mailbox structure is no longer valid.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 will be 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

 

Questions

5010 Inquires and Testing

Contact: EDI Support
Hours:
7:30am to 5:00pm Monday through Thursday
8:30am to 5:00pm on Friday

1-888-289-0709

EDIG.OPS-MCAID@palmettogba.com

 

SC Medicaid Trading Partner Enrollment

Report Fraud