**Revised** SC Paper Claim Requirements

Date:   07/16/2009

Recent healthcare legislation was adopted in South Carolina referred to as the Health Care Financial Recovery and Protection Act and requires compliance by June 11, 2009. Electronic claims may no longer be converted to paper for submission to a payer by a clearinghouse, billing service or any other vendor that contract with a provider to deliver health care claims to an insurer on the provider’s behalf.

Infinedi has consulted with a legal representative from the South Carolina Medical Association which defines an “electronic claim” as a claim submitted electronically using the ANSI 837 format. Infinedi will accept the ANSI 837 format but will also accept claims submitted in a print image format. A claim submitted in a print image format, which by the definition above would not be considered an electronic claim.

Effective 7/14/09 If you are submitting in the ANSI 837 format, Infinedi will reject claims routed to all South Carolina payers that do not accept electronic claims to prevent printing and mailing of paper claims, in accordance with South Carolina legislation. If the claim cannot be sent electronically to the payer, and the payer address contains the state code SC, we will reject the claim with the following error message:

Error: South Carolina Payer Requirement: Claim cannot be mailed.

If you are submitting claims in a print image format and the South Carolina payer does not accept electronic claims, or EDI Enrollment is not required for that payer, then we will print and mail the paper claim.

Provider Action:

• If you are sending print image, no action required
• If you are sending ANSI 837, be aware of the reject mentioned above.

http://www.scstatehouse.gov/sess117_2007-2008/bills/3674.htm

If you have questions regarding print image vs. ANSI 837 please contact our customer service department at 800-688-8087.