Bulletins




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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.

Post date: 11/15/2013 - 2:36pm

A. South Carolina Solutions acquisition by Molina Healthcare, Inc. B. Palmetto Physician Connection acquisition by Advicare C. Carolina Medical Home acquisition by WellCare of South Carolina

Post date: 11/15/2013 - 9:56am

The South Carolina Department of Health and Human Services (SCDHHS) expanded the availability of behavioral health pediatric screening tools in a Medicaid Bulletin, dated May 17, 2013.

Post date: 11/08/2013 - 3:56pm

South Carolina Department of Health and Human Services (SCDHHS) is accepting applications from entities interested in providing Medicaid Targeted Case Management (MTCM) services.

Post date: 11/04/2013 - 4:37pm

The South Carolina Department of Health and Human Services (SCDHHS) is implementing the following changes and clarifications effective December 1, 2013 to the Group Psychotherapy code and adding Multiple Family Group Psychotherapy code as outlined below:

Post date: 10/29/2013 - 1:08pm

Post date: 10/14/2013 - 1:53pm

The South Carolina Department of Health and Human Services (SCDHHS) will co-sponsor provider/facility training with the Medicaid QIO, Keystone Peer Review Organization, Inc., (KePRO).

Post date: 10/14/2013 - 1:46pm

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented a portion of a final rule under the Affordable Care Act (ACA) that increases Medicaid reimbursements for evaluation, management and immunization services to 100 percent of Medicare reimbursement for 2013 and 2014. The increase applies to both fee-for-service (FFS) and Managed Care Organization (MCO) plans.

Tags: Physicians
Post date: 09/26/2013 - 10:56am

Post date: 09/25/2013 - 4:17pm

Effective on October 1, 2013, United Healthcare Community Plan (UHCP) will cease operation as a Medicaid MCO in South Carolina. All members enrolled with UHCP on this date will be transferred to WellCare of South Carolina (WellCare) and will have the opportunity to choose a different health plan between October 1, 2013 and December 20, 2013.

Post date: 09/13/2013 - 5:11pm

Effective for dates of service on or after October 15, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will increase the rate for Synagis® to the current Average Wholesale Price (AWP) minus 18%. The new rate for the 100mg vial will be $2,429.18. The 50mg vial will be reimbursed at $1,286.44.

Post date: 08/30/2013 - 4:21pm

Effective October 1, 2013, as mandated by section 6407 (d) of the Affordable Care Act, prior to certifying a beneficiary’s eligibility for the home health benefit, the certifying physician must document that he or she, or an allowed non-physician practitioner (NPP) has had a face-to-face encounter with the beneficiary. The state plan Home Health benefit includes skilled nursing, home health aide and therapeutic services such as physical therapy, occupational therapy and speech therapy.

Post date: 08/29/2013 - 3:44pm

Post date: 08/14/2013 - 11:30am

On January 19, 2012, the South Carolina Department of Health and Human Services (SCDHHS) issued a bulletin titled “Long Acting-Reversible Contraceptives (LARCs) provided in a Hospital Setting”. In that bulletin, the agency indicated that coverage for LARCs would be considered an add-on benefit to the Diagnostic Related Group (DRG) reimbursement for all dates of service on or after March 1, 2012.

Tags: Hospitals
Post date: 08/08/2013 - 2:38pm

South Carolina Department of Health and Human Services (SCDHHS) is implementing a new provider-administered injectable drug program in conjunction with ICORE Healthcare, LLC SCDHHS and ICORE will be providing webinar trainings for providers on the PA process. The following dates and times are being offered.

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