Medicare Part D: The Medicare prescription drug benefit program. We call this program “Part D” for short. Medicare Part D covers outpatient prescription drugs, vaccines, and some supplies not covered by Medicare Part A or Medicare Part B or Medical Assistance. Our plan includes Medicare Part D.Medicare Part A: The Medicare program that covers most medically necessary hospital, skilled nursing facility, home health, and hospice care.
Medicare Part B: The Medicare program that covers services (such as lab tests, surgeries, and doctor visits) and supplies (such as wheelchairs and walkers) that are medically necessary to treat a disease or condition. Medicare Part B also covers many preventive and screening services.Medical Assistance: This is the name of Minnesota’s Medicaid program. Medical Assistance is run by the state and is paid for by the state and the federal government. It helps people with limited incomes and resources pay for long-term services and supports and medical costs.
It covers extra services and some drugs not covered by Medicare. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Claims

Forms

Form Name & DescriptionForm
Claim Reconsideration/Provider Appeals
-------Important Update!-------
Providers are required to submit your claim appeal electronically on our Provider Portal by selecting “Forms & Resources” then “Provider Appeal Form.” Call the Provider Contact Center at 1-888-633-4055 with any questions.		This form is no longer available.
Provider Adjustment Request Form4357 (pdf)
Attachment Cover Sheet4349 (doc)
Claims Error Codes & Descriptions
Troubleshooting help		5584 (pdf)

Submission Information

Use the chart below to find information for South Country Health Alliance claims submission. For pharmacy claims, see Pharmacy. Click here for additional claims submission information.

ServiceSubmission Information
Medical/Behavioral Health Services or ChiropracticSCHA Provider Portal (website)
1-888-633-4055
Payer Identification Number - 81600
Dental ServicesDelta Dental of Minnesota
P.O. Box 9120
Farmington Hills, MI 48333-9120
1-866-398-9419
Payer Identification Number - 07000

 

Minnesota Uniform Companion Guides
The Administrative Uniformity Committee (AUC) provides common billing practices for Minnesota payers and providers. The companion guides help determine the most appropriate practices for your agency/facility.

Minnesota Uniform Companion Guides (external website)

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