Understanding what Submission Clarification Codes (SCCs) are and how they should be utilized by the pharmacy within pharmacy revenue cycle management and prescription claims processing will help you accurately bill for prescription claims in order to receive maximum reimbursement and avoid costly audit triggers. This knowledge is important so that third-party payers understand the reason for the claims submission (or resubmission), improving claims adjudication accuracy.
But first, let’s understand what an SCC is, then we’ll explain its impact on your pharmacy.
What is an SCC?
SCCs are used by the pharmacy to clarify claim processing details and pertain to all classes of trade. These numeric codes are added to claims before submission (or resubmission) in order to, among other things:
- Communicate complete dispensing event details to the third-party payer, which facilitates more accurate third-party reimbursement that is aligned with payer contracts
- Help avoid negative outcomes from payer and regulatory audits through stronger pharmacy billing compliance and audit risk mitigation
- Limit claim rejections and reduce resubmission cycles through accurate, clean claim submission and strong pharmacy billing compliance practices
- Support a more efficient pharmacy workflow and overall operational efficiency by minimizing manual intervention and administrative rework in the claims process
