Bulletins




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Post date: 07/03/2014 - 1:53pm

SCDHHS will partner with participating Family Practice (FP) physicians in Allendale, Bamberg, Barnwell, & Hampton counties for the provision of prenatal care up to, but excluding delivery for low risk pregnancies.

Post date: 07/02/2014 - 11:23am

The notice that was posted regarding Medicaid Targeted Case Management (MTCM) providers on June 26, 2014, pertaining to Medicaid Targeted Case Management was intended only for newly enrolled private providers of MTCM. The intent was to advise newly enrolled private providers of MTCM of potential policy changes reflecting “conflict free” care management. Below is the updated correspondence distributed to newly enrolled private providers of MTCM. We apologize for any inconvenience.

Post date: 06/25/2014 - 4:44pm

This bulletin is to provide clarification regarding the election of the Hospice benefit for beneficiaries currently receiving the Optional Supplemental Care for Assisted Living Participants (OSCAP) service. Beneficiaries of Hospice and OSCAP may only receive personal care through one service or the other; therefore, they must choose either Hospice or OSCAP. An OSCAP participant residing in a Community Residential Care Facility (CRCF) has the right to choose which service they receive, as well as the option to choose the provider who delivers that service, if all medical necessity criteria are met.

Tags: Hospice
Post date: 06/23/2014 - 3:01pm

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after August 1, 2014.

Post date: 06/05/2014 - 11:08am

On April 1, 2014, it was announced that the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the DHHS Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.

Post date: 05/29/2014 - 4:28pm

Effective on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will update its policy to recognize the South Carolina Department of Health and Environmental Control (DHEC) Pulse Oximetry Screening test on newborns to detect congenital heart defects. Pulse oximetry is a noninvasive test that estimates the percentage of hemoglobin in blood that is saturated with oxygen.

Post date: 05/29/2014 - 4:11pm

Effective for services provided on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will allow for coverage of inpatient psychiatric care for beneficiaries of Medicare and Medicaid who are 65 or older.

Post date: 05/28/2014 - 1:13pm

Effective on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) has amended its Hospital Services Provider Manual and revised the section regarding Hospital Acquired Conditions (HACs). This section of the Hospital Services Provider Manual will apply to all Provider Preventable Conditions (PPCs) to include not only Hospital Acquired Conditions (HACs), but also Never Events (NEs) and Other Provider Preventable Conditions (OPPCs). The HACs section of the manual has been clarified to include a listing of all codes for HACs, NEs, and OPPCs, the criteria for non-payment, and how these codes will be captured in Medicaid’s reporting systems. In addition, the section has been amended to add the following eight OPPCs to the non-payment policy:

Post date: 05/23/2014 - 12:54pm

Effective with dates of service on or after July 1, 2014, the following codes and billing procedures must be utilized in order to receive payment for the Screening, Brief Intervention and Referral to Treatment (SBIRT) services.

Tags: Physicians
Post date: 05/23/2014 - 11:57am

Effective July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) has reinstated the Psychiatric and Psychotherapy Services section of the Physicians, Laboratories, and Other Medical Professionals Manual. This section applies to all physicians, psychiatrists, and psychiatric nurse practitioners providing psychiatric services, as well as allied professionals who may provide psychotherapy services under the supervision of these professionals. The Psychiatric and Psychotherapy Services section has been revised to reflect 2013 Current Procedural Terminology (CPT) guidelines and outlines the guidelines for supervision of services provided by allied professionals.

Post date: 05/23/2014 - 11:43am

Effective July 1, 2014, incontinence supply providers will be responsible for obtaining the Physician Certification of Incontinence SCDHHS Form 168IS prior to delivering Incontinence supplies. This policy replaces the June 18, 2013, memo titled Changes in Incontinence Supplies Authorizations, section 2 Physician’s Orders.

Post date: 05/21/2014 - 2:46pm

On January 16, 2014, the Centers for Medicare and Medicaid Services (CMS) published the final rule related to home and community based services under Section 1915 of Title XIX. The final rule addresses long-term care services and supports through home and community-based service programs under the 1915(c), 1915(i), and 1915(k) Medicaid authorities in the most integrated setting appropriate. The rule will require considerable work to comply with, and we believe by working together it presents an opportunity to enhance the quality of life for the individuals and families we mutually serve.

Post date: 05/20/2014 - 11:12am

Schedule of the free provider workshops offered by the SCDHHS to include Medicaid Basics, Comprehensive Web Tool, Overview of Third Party Liability and Overview of Claim-level Adjustments.

Post date: 05/12/2014 - 5:04pm

Effective with dates of service on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will implement policy changes to the Referral and Authorization process for acquiring Rehabilitative Behavioral Health Services (RBHS) and Inpatient Psychiatric Services for Children Under 21. These changes are being made in an effort to increase beneficiary access to medically necessary services and to increase efficiency of the current referral and authorization process for behavioral health services.

Post date: 05/02/2014 - 4:00pm

Effective June 1, 2014, South Carolina Department Health and Human Services will amend the non-emergency transportation policy for self- administered oxygen dependent beneficiaries discharged from inpatient hospitals or emergency rooms. This policy change affects Hospitals, Physicians, Ambulance and Durable Medical Equipment (DME) providers. This policy change will also be posted in the Hospital, Physicians Laboratories and Medical Professional, Ambulance and Durable Medical Equipment manuals located on the SCDHHS website: www.scdhhs.gov.

Post date: 05/02/2014 - 3:55pm

Medicaid Basics, Comprehensive Web Tool, Overview ofThird Party Liability and Overview of Claim-level Adjustments.

Post date: 04/29/2014 - 1:28pm

In May, South Carolina Healthy Connections Medicaid will host a series of training sessions on upcoming changes in the referral process for RBHS and PRTF. The training will cover the changes to the manual including the new referral processes for RBHS and PRTF services. A Medicaid Bulletin announcing the new policy change will be published prior to the trainings. Please monitor the SCDHHS website at https://www.scdhhs.gov/Medicaid-Bulletins for this proposed change.

Post date: 04/11/2014 - 4:38pm

All providers should disregard the South Carolina Department of Health and Human Services’ (SCDHHS) Bulletin with release date of March 27, 2014 regarding a change in the Screening, Brief Intervention and Referral to Treatment (SBIRT) codes and billing procedures effective May 1, 2014.

Post date: 04/11/2014 - 9:22am

Medicaid Basics, Comprehensive Web Tool, Overview of Third Party Liability and Overview of Claim-level Adjustments.

Post date: 03/28/2014 - 2:30pm

The South Carolina Department of Health and Human Services (SCDHHS) is issuing this bulletin to offer guidance to Rehabilitative Behavioral Health and Local Education Agency Providers. A Licensed Bachelor’s Social Worker can sign the Individual Plan of Care (IPOC) for a Medicaid beneficiary when the IPOC is not used for the purpose of medical necessity. Effective May 1, 2014, this policy will be retroactive to August 1, 2013.

Post date: 03/28/2014 - 9:43am

KEPRO’s, the QIO, primary role is to prior authorize (PA) select Medicaid services including, but not limited to inpatient admissions, therapy services for adults and children and Durable Medical Equipment (DME). Effective April 1, 2014, the number of days required for providers to submit requests to the QIO as well as response times for the QIO to render determinations have been changed or revised as indicated below.

Post date: 03/28/2014 - 9:28am

Medicaid Targeted Case Management (MTCM) is an available Medicaid covered service that helps individuals in gaining access to doctors, social services, educational resources, jobs and other services. Anyone who is Medicaid eligible and meets one of the following categories may qualify for MTCM:

Post date: 03/28/2014 - 9:23am

The South Carolina Department of Health and Human Services (SCDHHS) will implement a change to the billing frequency for Family Training and Counseling services. Effective with dates of service on or after April 1, 2014, the maximum billing frequency for Procedure Code T1027 will increase to 16 units or 4 hours daily.

Post date: 03/14/2014 - 4:21pm

Effective on April 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will reinstate the Adult Emergency Dental benefit. Medicaid enrolled dentists may seek reimbursement from the Fee-for-Service Healthy Connections program for emergency dental services to adults. The new adult benefit adds extractions for the relief of severe and acute pain or an infectious process in the mouth for adults age 21 and over that are eligible for Healthy Connections dental benefits. This new benefit is in addition to the services currently covered for the treatment of exceptional medical services (Section 4.07 of the Dental Office Reference Manual) and for the provision of emergency medical CPT procedures by oral surgeons (Section 4.06 of the Dental Office Reference Manual).

Tags: Dental
Post date: 03/07/2014 - 11:17am

This April MTCM providers will be able to select from the following dates and times:

Post date: 02/28/2014 - 3:33pm

On February 21, 2014, SCDHHS notified providers that 1099s for the week of October 29, 2013 were overstated. SCDHHS has resolved the issue, and the agency mailed corrected 1099s on March 3, 2014 to the approximately 5,000 providers whose original 1099 was not correct.

Post date: 02/28/2014 - 10:49am

Beginning with dates of service on or after March 17, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will reimburse for outpatient utilization of long acting reversible contraceptives (LARC) through the pharmacy program. Any LARC billed to SCDHHS by a pharmacy will be shipped directly to the provider’s office for insertion. Providers should take extra care to ensure that they bill Medicaid only for reimbursement of the insertion of the device, and not the device itself, when it is obtained and billed through the pharmacy benefit.

Post date: 02/21/2014 - 4:46pm

It has come to our attention that SCDHHS incorrectly overstated payment on the IRS Form 1099 for some enrolled providers. Only providers included in the October 29, 2013 payment cycle are affected. We are working with our technical teams and have consulted with the IRS about the best approach to correct this information on your behalf.

Post date: 02/20/2014 - 9:36am

Effective March 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will no longer require prior authorization on High Tech Radiology services. All other Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes requiring prior authorization or support documentation can be found in the Physicians, Laboratories and Other Medical Professional manual located at: www.scdhhs.gov.

Post date: 02/17/2014 - 2:32pm

New security policies implemented by the South Carolina Department of Health and Human Services (SCDHHS) requires all Electronic Data Interchange (EDI) Submitters, EDI Vendors, Clearinghouses, Billing Agents and South Carolina Medicaid Web-based Claims Submission Tool (Web Tool) users to change their password every 60 days. Any passwords that have not been changed will expire March 1, 2014. Please lo

Post date: 02/06/2014 - 5:07pm

Effective for dates of service on or after March 1, 2014, the South Carolina Department of Health and Human Services will expand the place of service that recipients age 21 and over are authorized to receive outpatient physical, occupational, and speech therapies (PT/OT/ST) services. In addition to receiving PT/OT/ST services in an outpatient hospital, beneficiaries can now receive these services in a physician’s office or outpatient rehabilitation facility. Services provided in a physician’s office or outpatient rehabilitation facility are limited to ambulatory therapies performed in an outpatient setting.

Post date: 02/06/2014 - 4:53pm

Effective with dates of services on or after January 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS), in accordance with the Current Procedural Terminology (CPT), will discontinue coverage of the deleted code for Speech Evaluation (92506) and activate the new procedure codes listed below. The following codes will be added to the list of reimbursable codes replacing the deleted procedure code 92506:

Post date: 02/04/2014 - 10:52am

The purpose of this assessment is to gauge the current state of overall ICD-10 readiness among our providers and help inform how we can best assist our providers through the transition to ICD-10. The questions in this assessment should take no more than 10 minutes to complete and all responses will remain anonymous. Please take the time now to complete this assessment.

Post date: 01/31/2014 - 2:10pm

Attached is a schedule of the free provider workshops offered by theSCDHHS to include Medicaid Basics, Comprehensive Web Tool, Overview ofThird Party Liability and Overview of Claim-level Adjustments.

Post date: 01/09/2014 - 9:35am

Attached is a schedule of the free provider workshops offered by the SCDHHS to include Medicaid Basics, Comprehensive Web Tool, Overview of Third Party Liability and Overview of Claim-level Adjustments.

Post date: 12/31/2013 - 12:24pm

The South Carolina Department of Health and Human Services (SCDHHS) has updated its reimbursement calculations for Medicare Deductible, Coinsurance, and Blood Deductibles to reflect the new 2014 Medicare Rates for Dually Eligible Medicaid members.

Post date: 12/23/2013 - 3:34pm

The South Carolina Department of Health and Human Services (SCDHHS) is issuing this bulletin for guidance on the provision of medically necessary dental services to children under the age of 21.

Tags: Dental
Post date: 12/20/2013 - 11:49am

This bulletin is to notify all service providers that the South Carolina Department of Health and Human Services (SCDHHS) has placed Logisticare on notice that a Corrective Action Plan (CAP) update is required in accordance with the SCDHHS Non-Emergency Medical Transportation (NEMT) contract.

Post date: 12/20/2013 - 10:56am

Effective immediately, the South Carolina Department of Health and Human Services (SCDHHS) will cover both Makena® and compounded hydroxyprogesterone caproate without prior authorization. SCDHHS will provide reimbursement directly to pharmacy providers for these products ordered by a prescriber.

Post date: 12/16/2013 - 11:44am

The Centers for Medicare and Medicaid Services (CMS) have announced that the Provider Enrollment Application fee for calendar year 2014 will be $542.00. This fee is required with any applicable enrollment application submitted on or after January 1, 2014, and on or before December 31, 2014.

Post date: 12/12/2013 - 2:02pm

Medicaid cards have been updated to reflect the new Healthy Connections logo, as pictured at right. Cards with the previous design (below right) are still in use and valid too, so please accept either version from your Medicaid beneficiaries.

Post date: 12/10/2013 - 9:29am

SCDHHS Offers Free Provider Workshops

Post date: 12/03/2013 - 4:59pm

The South Carolina Department of Health and Human Services is improving provider communications regarding the status of claims submitted to SC Medicaid. Effective January 3, 2014, providers will no longer receive Edit Correction Forms (ECFs) for rejected claims. Additionally, effective April 1, 2014, SC Medicaid will no longer accept provider corrected ECFs. Providers will be required to submit a new claim form to resolve billing edits. This change will allow SC Medicaid to keep providers informed of the status of each claim.

Post date: 12/02/2013 - 9:34am

Effective for dates of services on or after January 1, 2014, Robertson Optical will no longer be the contracted provider of eye wear for South Carolina Medicaid fee for service (FFS) participants. The South Carolina Department of Health and Human Services (SCDHHS) will no longer be acquiring this service through an exclusive contract. Beginning with dates of service on or after January 1, 2014, any enrolled and qualified provider producing eye wear may bill for this service.

Post date: 12/02/2013 - 9:13am

I. Preferred Drug List Update II. Exceptions to Prescription Limit III. Update to Synagis® (palivizumab) Reimbursement IV. Preferred Brand Medications V. Certificate of Medical Necessity for Home Infusion Pharmacies

Post date: 11/26/2013 - 12:56pm

In response to guidelines recommended by the National Uniform Claim Committee (NUCC) and set forth by the Centers for Medicare and Medicaid Services (CMS), the South Carolina Department of Health and Human Services (SCDHHS) is implementing the revised CMS-1500 Health Insurance Claim Form (02-12) version effective January 6, 2014.

Post date: 11/26/2013 - 10:01am

The South Carolina Department of Health and Human Services (SCDHHS) is pleased to announce changes to the Licensed Independent Practitioners Rehabilitative Behavioral Health Services Provider Manual.

Post date: 11/25/2013 - 4:40pm

Effective for dates of service on or after January 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) is will begin covering Tetanus, Diphtheria and Pertussis (Tdap) vaccination for adult beneficiaries, as recommended in the current version of the Center for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) Immunization Recommendations.

Post date: 11/15/2013 - 3:56pm

The South Carolina Department of Health and Human Services (SCDHHS) is requesting that LIP providers use KePRO’s Outpatient Prior Authorization Fax Form along with SCDHHS required documents as outlined in the Licensed Independent Practitioners Rehabilitative Services manual when requesting Prior Authorization for services. KePRO has the Outpatient Prior Authorization Fax Form located under the Forms tab on their website http://scdhhs.kepro.com/ . This form allows providers to inform KePRO of the codes requested for authorization, units requested, frequency, and dates of service and will help with timely authorizations

Post date: 11/15/2013 - 3:23pm

The South Carolina Department of Health and Human Services (SCDHHS) offers assistance with transportation for members that need help getting to and from most Medicaid covered services.

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