Extending DAODAS Providers' Coverage of Physician Services through Physician Group Enrollment
Effective immediately, the South Carolina Department of Health and Human Services (SCDHHS) will allow county substance use disorder authorities to enroll as physician group providers. This will expand the array of services substance use disorder authority providers may bill for South Carolina Healthy Connections Medicaid members. Reimbursement rates are listed in the physician fee schedules available here on SCDHHS’ website.
SCDHHS implemented these changes to enhance the state’s provider network and improve effective service delivery by supporting access to substance use disorder treatment services and medical management of such disorders.
Provider Enrollment Requirement to File Claims
For county substance use disorder authorities that would like to bill for services listed on SCDHHS' physician fee schedules that are not currently available in the DAODAS fee schedule, the county authority must separately enroll as a physician group provider.
Once enrolled, all claims for services listed on the physician fee schedules shall be submitted under the Medicaid identification number assigned to the physician group. Instructions on how to enroll as a physician group can be found here on SCDHHS' website. Medical providers may be employed or contracted by county substance use disorder authorities and may be enrolled in more than one physician group for Medicaid reimbursement.
For county substance use disorder authorities that are not incorporating additional services beyond those currently available in the DAODAS fee schedule, no action is needed.
South Carolina's Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in this bulletin for Healthy Connections Medicaid members who are enrolled in an MCO.
Providers should direct any questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Providers can also submit an online inquiry to the PSC at https://www.scdhhs.gov/providers/contact-provider-representative or may email questions to behavioralhealth004@scdhhs.gov.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.