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Submission Clarification Codes Decoded

Understanding what Submission Clarification Codes (SCCs) are and how they should be utilized by the pharmacy 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).

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:

• Provide the third-party payer with further details about the dispensing event 

• Clarify the claim submission details so the pharmacy receives proper reimbursement

• Help avoid negative outcomes from payer and regulatory audits

• Proactively prevent or override claim rejections

• Ensure claim accuracy

• Help create an efficient pharmacy workflow

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