Bulletins




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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

Bulletin: ICD-10 Clinical Modification/Procedure Coding System

Post Date: 06/01/2015 - 9:55am

Effective Oct. 1, 2015, claims submitted to the South Carolina Department of Health and Human Services (SCDHHS) must include the ICD-10 diagnosis or procedure codes for any claim with a date of service or date of discharge on or after Oct. 1, 2015.

Bulletin: Pharmacy Co-Payments Waiver

Post Date: 05/26/2015 - 9:58am

This policy applies only to the S.C. Medicaid Fee-for-Service (FFS) benefit.

Bulletin: Topical Fluoride Varnish Change In a Primary Care Setting

Post Date: 05/26/2015 - 9:52am

Effective for dates of service on or after July 1, 2015, trained staff in a primary care setting must begin billing Current Procedural Terminology (CPT) code 99188 on the CMS-1500 form when applying fluoride varnish.

Bulletin: MCMN Exception for Incontinence Providers

Post Date: 05/22/2015 - 9:16am

Effective July 1, 2015, SCDHHS will no longer require incontinence supply providers to obtain a Medicaid Certificate of Medical Necessity (MCMN) (Form DME001) for gloves provided to Healthy Connections Medicaid members enrolled in the Community Support Waiver, Head and Spinal Cord Injury Waiver and Intellectual Disabilities/Related Disabilities Waiver.

Bulletin: Hepatitis C Virus (HCV) Pharmacy Benefit Carve Out

Post Date: 05/22/2015 - 9:11am

Effective with dates of service on or after July 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will carve out coverage for medications used to treat Hepatitis C Virus (HCV) from the Managed Care Organization (MCO) benefit.

Provider Alert: Provider Revalidation

Post Date: 05/21/2015 - 1:17pm

Bulletin: Revised Family Planning Examination/Visits

Post Date: 05/06/2015 - 11:11am

SCDHHS no longer requires a physical examination during an initial Family Planning visit in order to prescribe hormonal contraception.

Bulletin: Autism Spectrum Disorder Services Interim Process

Post Date: 04/22/2015 - 12:54pm

Members 0-21 years old are eligible to submit requests for ASD services, including members currently on the Pervasive Developmental Disorder (PDD) Waiver waiting list as well as those whose PDD Waiver services have expired.

Bulletin: Provider Enrollment Revalidation

Post Date: 04/20/2015 - 2:41pm

Providers enrolled in the South Carolina Healthy Connections Medicaid program must have their enrollment revalidated by SCDHHS on or before March 25, 2016.

Bulletin: Rehabilitative Behavioral Health Services Changes

Post Date: 04/13/2015 - 7:12pm

The South Carolina Department of Health and Human Services (SCDHHS) will implement the following changes to the Rehabilitative Behavioral Health Services (RBHS) policy. These changes apply to fee for service RBHS only and are effective May 1, 2015, unless otherwise specified in this bulletin.

Bulletin: EPSDT Pediatric Screening Tools

Post Date: 03/31/2015 - 4:47pm

Effective January 1, 2015, SCDHHS added Current Procedural Terminology (CPT) code 96127 to break out the services of emotional and behavioral assessments from developmental screening reported with CPT code 96110.

Provider Alert: Deemed Baby Claims 712 Edit Code

Post Date: 03/26/2015 - 12:49pm

Provider Alert: ICD-10 Introductory Classes

Post Date: 03/13/2015 - 3:57pm

Bulletin: Rehabilitative Behavioral Health Services Frequently Asked Questions

Post Date: 03/13/2015 - 12:38pm

On Feb. 20, the South Carolina Department of Health and Human Services (SCDHHS) released a bulletin on changes to the Rehabilitative Behavioral Health Services (RBHS) policy, effective March 1, 2015. These changes, which only apply to fee for service, include medical necessity and prior authorizations, staff credentials, staff to client ratio, frequency limits and reimbursement rates and modifier changes.

Bulletin: Modification to Federally Qualified Healthcare Center (FQHC) Claims Submission Criteria

Post Date: 03/02/2015 - 3:24pm

Changes to Federally Qualified Healthcare Centers (FQHCs) enrollment and claims submission criteria.

Bulletin: Rehabilitative Behavioral Health Services Changes

Post Date: 02/20/2015 - 7:20pm

Effective March 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will implement the following changes to the Rehabilitative Behavioral Health Services (RBHS) policy. These changes apply to fee for service RBHS only.

Bulletin: Healthy Connections Checkup: Colorectal Cancer Screening Benefits

Post Date: 02/13/2015 - 4:11pm

Effective immediately, the following codes are now billable under the Healthy Connections Checkup (Checkup) colorectal cancer screening benefit. These services are available once every 10 years for patients 50-75 years old. An FP modifier must be appended to the following Current Procedural Terminology (CPT) codes.

Bulletin: RBHS Provider Enrollment Moratorium

Post Date: 02/06/2015 - 3:28pm

Effective immediately the South Carolina Department of Health and Human Services (SCDHHS) is imposing a moratorium on the enrollment of Rehabilitative Behavioral Health Services providers.

Provider Alert: 642 Edit Claims

Post Date: 02/04/2015 - 5:06pm

Bulletin: Coverage of Hydroxyprogesterone Injection

Post Date: 02/04/2015 - 10:33am

On July 3, 2014, the Food and Drug Administration issued updated guidance in regards to hydroxyprogesterone caproate.

Bulletin: Behavioral Health Providers

Post Date: 01/27/2015 - 1:40pm

New Billing Procedure Code for Child and Adolescent Level of Care Utilization System (CALOCUS) & Procedure Code Change for Initial Assessment

Bulletin: 2015 Medicare Deductible, Coinsurance and Medicaid Blood Deductible Rates for Dual-Eligible (Medicaid and Medicare) Members

Post Date: 01/16/2015 - 10:03am

SCDHHS’ payment for dual-eligible (Medicaid and Medicare) members is equal to the allowed amount minus the Medicare payment or the sum of the Coinsurance, Deductible and Blood Deductible (up to three units), whichever is less.

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