Electronic Submission of Claims with Private Health Insurance Primary

The South Dakota Medicaid Program recently became aware of an adjudication discrepancy when processing electronic claim submissions for claims indicating a private health insurance (PHI) payment primary. The Medicaid payments did not acknowledge the applicable PHI payment per claim line beyond the first line of every claim, resulting in overpayments for all multiple line claims. SD Medicaid hopes that most providers identified these overpayments through weekly resolution of their Remittance Advices resulting in either claim adjustment/void submissions, or refund checks back to the program. The Division of Medical Services has corrected the adjudication error.