Electronic Data Interchange (EDI)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law intended to promote the privacy and security of protected health information, and promote efficiency through the use of standard transactions of patient information. This law has effected significant changes in the submission of claims to South Carolina Medicaid.

Providers who conduct electronic transactions with South Carolina Medicaid must comply with HIPAA requirements to use national standard transaction sets and code sets. South Carolina Medicaid continues to accept paper claims; however, paper billers must also use national codes.

The information below maps the various claims submission methods to resources for compliant claims submission. To access detailed information about a specific resource, click on the EDI resource link; or, you may access the link located to the left of this home page.

 

Claim Submission Methods

EDI Resource Link

Electronic (Tape,CD,FTP, Zip File, Diskette, Modem)

S.C. Medicaid Web-Based Claims Submission Tool

Paper

ANSI X-12 Implementation Guides

X

 

 

South Carolina Medicaid Companion Guides

X

 

 

South Carolina Medicaid Trading Partner Enrollment

X

X

 

South Carolina Medicaid Crosswalks to National Codes

X

X

X


Disclosure of Ownership and Control Interest Statement SCDHHS Form 1514