South Carolina Pharmacy Services
This website is intended to assist in questions related to the South Carolina Medicaid Pharmacy Point of Sale Program. For questions related to other benefits under South Carolina Medicaid, please see http://www.scdhhs.gov.
Coordination of Benefits
SC Medicaid is always the payer of last resort. When a SC Medicaid beneficiary has other insurance coverage, pharmacy providers are required to bill all other insurance carriers before billing SC Medicaid.
There are 4 fields that are required to process a Medicaid COB claim:
- Other Coverage Code (OCC) (NCPDP field # 308-C8)
- Other Payer Date (NCPDP field # 443-E8)
- (Insurance) ID Qualifier (NCPDP field # 339-6C) – Always use “99”
- Other Payer ID (NCPDP field # 340-7C)
The Carrier Code (Payer ID) to be populated in the “Other Payer ID” field may be found by clicking on one of the following links:
Our COB Reference Guide may be a useful tool when submitting COB claims to SC Medicaid. Please click on the link below to access this document:
These documents are also located under the “Pharmacy” tab, under “Documents”.
Managed Care Health Plans
For information on the Managed Care Health Plans and their Pharmacy Benefit Managers (PBM) within the state of SC, please visit: www.scdhhs.gov/insidedhhs/bureaus/BureauofHealthServicesandDeliverySystems/managedcare.asp
Pharmacy Clinical Alerts
Check out the latest edition of “Pharmacy Clinical Alerts”.
Paper Claims Submissions
Please note that the address for sending paper claims has changed. Future submissions of paper claims should be sent to the following address:
Magellan Medicaid Administration
Post Office Box 85042
Richmond, VA 23261-5042
Rx Insight: Apply and Comply
Interested in the latest news pertaining to the SC Medicaid Provider Community? View the current provider newsletter.
South Carolina Medicaid offers Pharmacy Web Prior Authorization (Web PA), a web-based application developed by Magellan Medicaid Administration which allows prescribers to request PAs online and receive real-time approvals. Web PA is offered in addition to a telephone call or fax to request a PA. It offers a wide array of features including electronic submission of a prior authorization request, ability to view the status of a PA, an option to edit or delete incomplete requests, access to list of drugs that require a prior authorization, and a secure transaction of confidential information to comply with HIPAA guidelines.
Note: Prior to obtaining access to the Pharmacy Web Prior Authorization tool, prescribers or the designated delegated administrator must access the User Administration Console (UAC) to request a personal identification number (PIN), register with the PIN, and create a user id/ password. Now is the perfect opportunity to access the User Administration Console by clicking on the UAC link in the upper right hand corner of this screen. There are instructions, educational documents, and online presentations available in the Reference collection link in the upper right hand corner of this screen. Magellan Medicaid Administration also provides a Web Support Call Center (800-241-8726) for assistance with any questions you may have during this process.
Medicaid Bulletin Subscriptions
All Medicaid Bulletins will be sent by email and can be viewed at your convenience online at www.scdhhs.gov. To make certain that you receive bulletins in the near future, please visit http://bulletin.scdhhs.gov/.
Note: If you are currently receiving bulletins from the "Medicaid Bulletins" email address, you must re-subscribe. For full details see the Medicaid Bulletin dated August 26, 2008.
Provider Support Mailbox
For assistance with claims processing for SC Medicaid through POS or to receive SC Medicaid pharmacy updates by email please contact the Provider Support Team at SCprovidersupport@magellanhealth.com.