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:
http://southcarolina.fhsc.com/Downloads/provider/SCRx_TPLcodes_byName.pdf
http://southcarolina.fhsc.com/Downloads/provider/SCRx_TPLcodes_byCode.pdf

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:
http://southcarolina.fhsc.com/Downloads/provider/SCRx_Reference_Guide_Coordination_of_Benefits.pdf

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: https://msp.scdhhs.gov/managedcare/

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:

Prime Therapeutics State Government Solutions
Post Office Box 85042
Richmond, VA 23261-5042

Medicaid Bulletin Subscriptions

All Medicaid Bulletins will be sent by email and can be viewed at your convenience online at https://www.scdhhs.gov/Medicaid-Bulletins. To make certain that you receive bulletins in the near future, please sign up to receive the latest news and updates.

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.

Support Mailboxes

For assistance with claims processing for SC Medicaid through POS, please contact our support team at SCprovidersupport@primetherapeutics.com.

For MCOs or PBMs that have inquiries pertaining to PA criteria, PDL, P&T questions or the weekly file please reach out to SCSinglePDL@primetherapeutics.com.

For Pharma representative inquiries pertaining to meetings, P&T or PDL questions reach out to SCPharma@primetherapeutics.com.