MHN/MCO Eligibility Verification Feature Now Available


Effective Tuesday, June 12, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will add a new feature to the SC Web-based Claims Submission Tool (Web Tool).  The Web Tool will display the name, address and telephone number of the Medical Home Network (MHN) and Managed Care Organization (MCO) for those beneficiaries enrolled in a managed care plan.  This information will be displayed in the ‘Beneficiary Special Programs Data’ section when viewing the ‘Eligibility Verification Results’ screen.  For 270/271 Health Care Benefit Inquiry and Response transactions, the Medical Home Network, name, address and telephone number will come in an additional NM1 segment, of loop 2120, with the value NM101 code of ‘GW’. The NM1 segment for Managed Care Organization will have a NM1 code of ‘1I’. The Primary Care Physician, name, address and telephone number will follow as it has in the past.

Providers should continue to request a referral from the primary care provider (PCP) for MHN enrolled beneficiaries.  If the PCP is unable to provide a referral, providers should call the phone number listed for the beneficiary’s MHN.  NOTE:South Carolina Solutions will be reflected as Community Health Solutions within the WebTool.

The Managed Care anniversary date is a new feature displayed in the ‘Beneficiary Special Programs Data’ section and will be activated soon.  SCDHHS understands the importance of managing your beneficiary lists with efficiency and accuracy.  We are working expeditiously to make this available.

For more information about using the functions of the Web Tool, explore one of the many training options and provider resources that are available on the Provider Education Web site, you have any additional questions or concerns, please contact the Provider Service at 1-888-289-0709. 

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