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South Carolina Medicaid
Coordination of Benefits
General Info

Providers must bill all other insurance
carriers before billing SC Medicaid

If payment is received from multiple
payer sources, Medicaid requires
Total Amount Paid in “Other Payer
Amount Paid” field
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SC Medicaid is Always Payer of Last Resort
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Compliance is Key

If a primary carrier requires a PA, the primary carrier’s prior
authorization procedures must be followed
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Fields Required in Processing Medicaid
Secondary Claims

Other Coverage Code (OCC)
(NCPDP field # 3Ø8-C8)

Other Payer Date
(NCPDP field # 443-E8)

ID Qualifier =“99”
(NCPDP field # 339-6C)

Other Payer ID
(NCPDP field # 34Ø-7C)
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Other Coverage Codes
(NCPDP field # 3Ø8-C8)
Other Coverage Codes
(NCPDP field # 3Ø8-C8)


Enter OCC of 2 if payment was received from primary insurer

Enter primary insurer payment amount in the “Other Payer Amount Paid”
field (NCPDP 431-DV)

Effective September 15th, 2010 providers must populate patient’s
copayment in the “Patient Paid Amount Submitted” field (NCPDP 433-DX)
Enter OCC of 3 if a particular drug is not covered by an individual’s
active primary/secondary coverage

Effective September 15th, 2010 the reject code after billing the primary
insurer should be populated in the “Other Payer Reject Code” field (NCPDP
472-E)
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Other Coverage Codes
(NCPDP field # 3Ø8-C8)

Enter OCC of 4 if instructed to collect money from patient for not
meeting deductible or co-pay with active primary insurance (No
changes for the OCC of 4)

Enter OCC of 7 if verified by insurance carrier that beneficiary has no
other coverage on date of service
 Effective September 15th, 2010 the reject code after billing the primary
insurer should be populated in the “Other Payer Reject Code” field (NCPDP
472-E)
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Other Payer ID
(NCPDP field # 34Ø-7C)
Insurance Carrier Codes

http://southcarolina.fhsc.com/providers/rxdocuments.asp
Click one of the
links to access
Insurance Carrier
Codes to enter in
the “Other Payer
ID” field
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Don’t Forget!


Do not use a 1, 5, 6, or 8 in the OCC Field-(claim will reject)
Medicaid does not coordinate benefits with Medicare Part D or with a
beneficiary’s creditable coverage
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Required on ALL COB claims
Field Name
NCPCP field #
Other Coverage Code (OCC)
3Ø8-C8
Other Payer Date
443-E8
ID Qualifier
339-6C
Other Payer ID
34Ø-7C
Required on ALL OCC= 2 claims
Field Name
NCPDP field #
Other Payer Amount Paid
431-DV
Patient Paid Amount Submitted
433-DX
Required on ALL OCC= 3 claims
Field Name
NCPDP field #
Other Payer Reject Code
472-6E
Required on ALL OCC= 4 claims
Field Name
NCPDP field #
No additional fields required
N/A
Required on ALL OCC= 7 claims
Field Name
Other Payer Reject Code
NCPDP field #
472-6E
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Contacts

Magellan Medicaid Administration


[email protected]
SCDHHS

Janet Giles


Brandie Crider


[email protected]
[email protected]
Phone: 803-898-2876
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