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  Enrollment/Disenrollment

 
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How can I tell if a patient is enrolled with an MCO or is in one of the MHN programs?


ALL eligibility and enrollment can be verified using one of the following:
  • The SCDHHS WebTool which is free of charge. For more information call 888-289-0709


  • The Medicaid eligibility Voice Response System at 888-809-3040


  • One of the availble card swipe systems


Upon checking eligibility, providers will be able to determine managed care participation. The WebTool will list the name and phone number of the MCO, or the name and phone number of the primary care physician for beneficiaries enrolled in an MHN. The IVRS will provide the same information, however it is not shared until the end of the message.

Providers should also ask the beneficiary for their Medicaid and health plan benefit cards; however, possession of a card does not guarantee eligibility. If the beneficiary is in a Managed Care Organization, the beneficiary should have an MCO identification card in addition to the Medicaid ID card.

You must check eligibility before each visit as Medicaid status may change on a daily basis.


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