Bulletins
Bulletin: Pediatric Screening (CPT) 96127
Post Date: 09/26/2016 - 2:47pm
Effective Nov. 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will limit payment for Current Procedural Terminology (CPT) code 96127 to a maximum of two units per date of service.
Provider Alert: Deadline for Provider Revalidation is Sept. 24; Provider Termination is Sept. 25
Post Date: 09/13/2016 - 1:04pm
Provider Alert: Reimbursement Rate Update for Long Acting Reversible Contraceptives (LARCs)
Post Date: 08/08/2016 - 4:18pm
Bulletin: Coverage of Drug Testing Codes
Post Date: 07/21/2016 - 3:21pm
Effective for dates of service beginning Jan. 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will cover the following presumptive and definitive drug testing codes at the reimbursement rates as stated in the attached table.
Provider Alert: 2016: Last Chance to Begin Participation in the South Carolina Medicaid Electronic Health Records Incentive Program
Post Date: 07/18/2016 - 1:33pm
Bulletin: New Medicaid Cards
Post Date: 07/11/2016 - 11:47am
The new card, effective August 1, 2016, will no longer contain a magnetic data strip on the backside.
Provider Alert: Compliance with Federal Non-discrimination Requirements
Post Date: 06/28/2016 - 2:43pm
Bulletin: Changes to Age Limitations for Certain Dental Procedures
Post Date: 06/23/2016 - 8:58am
Effective for all claims submitted on or after Aug. 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will lower the age limitation for the codes listed in the table below. This change is to adhere to best practice guidelines.
Provider Alert: Changes to the SCDHHS Preferred Drug List Effective July 1, 2016
Post Date: 06/17/2016 - 8:48am
Bulletin: Coverage of Bariatric Surgery
Post Date: 06/08/2016 - 1:32pm
SCDHHS will expand the bariatric surgery benefit to include coverage of sleeve gastrectomy.
Bulletin: Revisions to Rehabilitative Behavioral Health Services Policy and Procedures
Post Date: 06/01/2016 - 2:35pm
Changes will be effective with dates of service on or after July 1, 2016. This bulletin provides notice and an overview of revisions effective July 1, 2016; it is not intended to reflect all revisions in the manual. The RBHS manual may be subject to further change.
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: Outpatient and Rehabilitative Behavioral Health Services Managed Care Training
Post Date: 03/02/2016 - 1:25pm
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.
Provider Alert: SCDHHS and KEPRO Provider Quality Improvement Training
Post Date: 02/24/2016 - 11:42am
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.
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: Healthy Connections Prime Passive Enrollment Scheduled to Begin April 2016; Seniors in South Carolina now have a new health care option
Post Date: 01/22/2016 - 11:54am
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.
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.
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.
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