Bulletins




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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.

Bulletin: Sickle Cell Disease Management Program

Post Date: 12/18/2014 - 12:44pm

Effective on or after January 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will update its Disease Management program to include sickle cell disease. Sickle Cell Disease Management (SCDM) is available to Medicaid eligible individuals determined to have a confirmed diagnosis of sickle cell disease as defined by the Centers for Disease Control and Prevention (CDC) and are not simultaneously receiving Targeted Case Management or any other coordination/management service for sickle cell disease.

Bulletin: SCDHHS Offers Free Provider Workshops

Post Date: 12/08/2014 - 11:43am

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

Provider Alert: Deemed Baby Process

Post Date: 12/05/2014 - 5:14pm

Bulletin: Healthy Connections Now Provides Adult Dental Benefits

Post Date: 12/01/2014 - 4:17pm

Dental health is a key part of improving and maintaining your health. The health of your teeth and gums can affect the health of the rest of your body.

Provider Alert: Co-payments

Post Date: 12/01/2014 - 10:03am

Bulletin: ACA Enhanced Physician Payment Reimbursement Discontinued. Primary Care Fee Schedule Enhancement

Post Date: 12/01/2014 - 9:38am

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented a portion of the final rule under the Affordable Care Act (ACA) that increased Medicaid reimbursements for evaluation, management and immunization procedure codes for two years. The increase applied to both fee-for-service (FFS) and Medicaid Managed Care Organizations (MCOs).

Bulletin: Intensive Family Services (Procedure code H0046)

Post Date: 11/17/2014 - 3:50pm

The South Carolina Department of Health and Human Services will add Intensive Family Services (IFS) to the Rehabilitative Behavioral Health Services Manual and the Licensed Independent Practitioners Rehabilitative Services Manual effective January 1, 2015.

Bulletin: Claim Reconsideration Policy-Fee For Service (FFS) Medicaid

Post Date: 11/14/2014 - 9:11am

Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy.

Bulletin: Policy Revisions to the Local Education Agency (LEA) Services Manual for Rehabilitative Behavioral Health Services (RBHS)

Post Date: 11/13/2014 - 4:45pm

1. Discontinue the requirement of the FORM 255 2. Relocate the Psychological Testing and Evaluation policy to the RBHS section of the manual

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