Bulletins




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Bulletin: Payment Error Rate Measurement (PERM)

Post Date: 04/29/2016 - 11:19am

The Centers for Medicare and Medicaid Services (CMS) will measure the accuracy of Medicaid and CHIP payments made by states for services rendered to recipients through the Payment Error Rate Measurement (PERM) program.

Bulletin: Medicaid Targeted Case Management (MTCM) Moratorium

Post Date: 03/11/2016 - 4:44pm

Effective immediately the South Carolina Department of Health and Human Services (SCDHHS) is imposing a moratorium on the enrollment of Medicaid Targeted Case Management (MTCM) providers.

Provider Alert: Provider Workshops: March-May

Post Date: 03/11/2016 - 2:32pm

Bulletin: Rehabilitative Behavioral Health Providers – Provider Qualifications

Post Date: 03/01/2016 - 1:59pm

The South Carolina Department of Health and Human Services (SCDHHS) is revising the Rehabilitative Behavioral Health Services (RBHS) Policy Manual. Changes will be effective on or after April 1, 2016.

Bulletin: Required use of the South Carolina Reporting & Identification Prescription Tracking System (SCRIPTS)

Post Date: 02/23/2016 - 2:45pm

Beginning with dates of service on or after April 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will require that providers verify Medicaid members' controlled substance prescription history through the South Carolina Reporting & Identification Prescription Tracking System (SCRIPTS) before issuing a prescription for any Schedule II through IV controlled substance.

Provider Alert: Resources for Background Checks

Post Date: 02/19/2016 - 2:36pm

Bulletin: Ambulance Services Provider Manual Update

Post Date: 02/02/2016 - 10:07am

An update to sections three and four of the Ambulance Services Provider Manual will make a clear distinction between the current requirements for submitting claims with modifiers and origin/destination codes.

Bulletin: Autism Spectrum Disorder Services Interim Process – Phase Two

Post Date: 01/28/2016 - 5:12pm

Effective Feb. 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will initiate an improved interim process by which its members are evaluated for and receive Autism Spectrum Disorder (ASD) services that are identified as medically necessary based on an Early and Periodic Screening Diagnosis and Treatment (EPSDT) encounter.

Bulletin: Updates to Section 1 - All Provider Manuals

Post Date: 01/27/2016 - 10:28am

Effective Jan. 1, 2016, Section 1 of all South Carolina Medicaid Provider Manuals have been updated to reflect changes to the following policies: SC Medicaid program, Records/documentation requirements, Medicaid program integrity, & Appeals

Provider Alert: New Provider Workshops

Post Date: 01/26/2016 - 4:33pm

Bulletin: Rescind Physical Medicine and Therapy Policy Update; Medicaid Bulletin #14-001 Released Feb. 6, 2014

Post Date: 12/11/2015 - 4:59pm

Effective immediately the South Carolina Department of Health and Human Services (SCDHHS) is rescinding the policy, bulletin 14-001 released Feb. 6, 2014, that allowed services delivered to recipients 21 years and over in place of service (62) Outpatient Rehabilitation Facility. Beneficiaries will continue to receive outpatient physical, occupational and speech therapies (PT/OT/SP) services in an outpatient hospital, clinic or office setting.

Provider Alert: Provider Revalidation Group 6

Post Date: 12/11/2015 - 4:49pm

Bulletin: Medicaid Payment for Services Provided Without Charge (Free Care)

Post Date: 12/10/2015 - 9:30am

The Centers for Medicare and Medicaid Services (CMS) recently amended policies regarding Medicaid reimbursement to Medicaid providers for the delivery of state plan-approved services that are available to Medicaid eligible beneficiaries, without charge to the beneficiary (including services that are available without charge to the community at large, or “free care”).

Bulletin: Revisions to Rehabilitative Behavioral Health Services Policy and Procedures

Post Date: 12/04/2015 - 4:46pm

Changes will be effective on or after Jan. 1, 2016. The intent of this bulletin is to provide notice of general revisions; it is not intended to reflect all revisions in the manual.

Bulletin: Medicaid Status Inquiry/Release of Information Requirement

Post Date: 11/17/2015 - 1:53pm

Providers may use one of the methods listed below to verify Medicaid enrollment or verify the status of an individual’s application.

Bulletin: Prior Authorization Schedule

Post Date: 11/12/2015 - 10:58am

SCDHHS will implement the following one-time change to the Rehabilitative Behavioral Health Services (RBHS) prior authorization (PA) schedule for beneficiaries age 0-21.

Provider Alert: Provider Revalidation Group 5

Post Date: 10/28/2015 - 4:53pm

Bulletin: Physician Assistant Enrollment

Post Date: 10/26/2015 - 12:51pm

All licensed Physician Assistants (PAs) providing services to Healthy Connections beneficiaries must be enrolled as providers with the South Carolina Department of Health and Human Services (SCDHHS). PAs providing services to Medicaid Managed Care enrolled members must also be enrolled and credentialed with the member’s Managed Care Organization (MCO).

Bulletin: Revisions to Rehabilitative Behavioral Health Services Policy and Procedures - Administrative Changes

Post Date: 10/01/2015 - 10:00am

Effective Nov. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will implement modifications to the Rehabilitative Behavioral Health Services (RBHS) Policy Manual. These manual revisions will strengthen fee-for-service Medicaid requirements related to several areas of the provider manual including:

Bulletin: Update to Policy Manual Regarding Long Acting Reversible Contraceptives (LARCs)

Post Date: 09/29/2015 - 2:10pm

Update to the Hospital Services Provider Manual to reflect the Medicaid policy for immediate inpatient insertion of Long Acting Reversible Contraceptives (LARCs)

Bulletin: Medicaid Targeted Case Management Service Review Process

Post Date: 09/28/2015 - 10:23am

The South Carolina Department of Health and Human Services (SCDHHS) will implement a review process on Medicaid Targeted Case Management Services (MTCM) rendered by private providers of MTCM. Effective Nov. 1, 2015, SCDHHS will reimburse for no more than 24 units per calendar quarter per beneficiary unless medical necessity has been demonstrated and approved through the prior authorization process defined in the Oct. 1, 2015, edition of the MTCM Provider Manual. The 24-unit allowance applies to any combination of face to face or telephonic MTCM. For the October-December 2015 calendar quarter, payment for services incurred in October 2015 in excess of the 24-unit limit will not be retroactively denied due to this change.

Provider Alert: Provider Revalidation: Group 4

Post Date: 09/16/2015 - 4:58pm

Bulletin: Pre-eligibility Medical Expenses and Calculations of Recurring Income for Long Term Care Beneficiaries

Post Date: 09/07/2015 - 1:58pm

Pre-eligibility Medical Expenses and Calculations of Recurring Income for Long Term Care Beneficiaries

Bulletin: Dental Claim Submission Requirements & Dental Policy Updates

Post Date: 08/28/2015 - 10:44am

Effective Oct. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will require providers to submit the 2012 American Dental Association (ADA) claim form, or its corresponding Electronic Data Interchange (EDI) format, when filing dental or oral surgical claims services using Common Dental Terminology (CDT) procedure codes. Previously used ADA claim forms and their accompanying EDI formats will be rejected for all claims submitted on or after Oct. 1, 2015.

Provider Alert: Provider Revalidation: Group 3

Post Date: 08/10/2015 - 10:57am

Bulletin: Health Insurance Premium Payment (HIPP) Program to Cover Monthly Individual Health Insurance Premiums for Eligible Medicaid Beneficiaries

Post Date: 07/23/2015 - 11:28am

The HIPP program is a cost-containment initiative that maintains premium payments for Medicaid beneficiaries who retain private health insurance when cost-effective to the Medicaid program. HIPP enrollment is contingent upon a HIPP applicant's Medicaid eligibility and cost-effectiveness.

Bulletin: Nutritional Counseling Bulletin.

Post Date: 07/02/2015 - 3:14pm

SCDHHS will implement a policy for nutritional counseling. SCDHHS is currently enrolling Licensed Dietitians (LDs) and these providers will be able to provide nutritional counseling services for obesity, effective with dates of service on or after August 1, 2015.

Provider Alert: Provider Revalidation

Post Date: 06/26/2015 - 4:35pm

Bulletin: Provider Enrollment Application Fee & Participation and Payment Agreement

Post Date: 06/25/2015 - 11:11am

Effective Aug. 1, 2015, the provider enrollment application fee will only be applicable to providers that the Centers for Medicare & Medicaid Services (CMS) has identified as institutional providers.

Bulletin: Delivery of Medical Equipment and/or Supplies

Post Date: 06/24/2015 - 3:51pm

Effective Aug. 1, 2015, SCDHHS will amend the delivery method policy for Durable Medical Equipment (DME) providers.

Bulletin: Claim Submission Web Portal (Webtool) Enhancement

Post Date: 06/22/2015 - 9:44am

Beginning Aug. 17, 2015, the electronic claim submission web portal (Webtool) will be enhanced to allow the attachment of documentation to claims

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