Bulletins




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Bulletin: High Tech Radiology Services

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.

Bulletin: Avoid disruption of electronic claims submissions

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

Bulletin: Physical Medicine and Therapy Policy Update

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.

Bulletin: New Speech Therapy Codes

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:

Bulletin: SMA ICD-10 Provider Readiness Assessment

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.

Bulletin: SCDHHS Offers Free Provider Workshops

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.

Bulletin: SCDHHS Offers Free Provider Workshops

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.

Bulletin: 2014 Medicare Deductible, Coinsurance and Medicaid Blood Deductible Rates for Dually Eligible Medicaid Members

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.

Bulletin: EPSDT Policy Clarification

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.

Bulletin: Logisticare - Corrective Action Plan to Address Non-compliance

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.

Bulletin: Coverage of Hydroxyprogesterone Caproate Injection

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.

Bulletin: Provider Enrollment Application fee

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.

Bulletin: Medicaid cards now have a new design

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.

Bulletin: SCDHHS Offers Free Provider Workshops

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

SCDHHS Offers Free Provider Workshops

Bulletin: Discontinuation of Edit Correction Forms (ECFs)

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.

Bulletin: Vision Care Services Policy Update

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.

Bulletin: Preferred Drug List Update, Exceptions to Prescription Limit, Update to Synagis® (palivizumab) Reimbursement, Preferred Brand Medications and Certificate of Medical Necessity for Home Infusion Pharmacies

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

Bulletin: Transition to the CMS-1500 Health Insurance Claim Form (02-12) version

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.

Bulletin: Licensed Independent Practitioners Rehabilitative Services Policy

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.

Bulletin: Tetanus, Diphtheria and Pertussis (Tdap) Vaccine

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.

Bulletin: KePRO Outpatient Prior Authorization Fax Form. Changes in LIP Policy effective Jan. 1, 2014

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

Bulletin: South Carolina Non-Emergency Medical Transportation

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.

Bulletin: Managed Care Organizational Changes. Explanation of the Organizational Changes

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

Bulletin: Behavioral Health Screening Tools Clarification

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.

Bulletin: Medicaid Targeted Case Management (MTCM) services

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.

Bulletin: Behavioral Health is revising the description of Group Psychotherapy and adding Multiple Family Group Psychotherapy to the Behavioral Health Manual

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:

Bulletin: SCDHHS Offers Free Provider Workshops

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

Bulletin: Quality Improvement Organization (QIO) Training Session

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).

Bulletin: Enhanced Physician Payments for Allergy and Immunology Providers

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.

Bulletin: SCDHHS Offers Free Provider Workshops

Post Date: 09/26/2013 - 10:56am

Bulletin: Managed Care Organizational Change, Clarification of Changes

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.

Bulletin: Synagis

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.

Bulletin: Home Health Policy Updates

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.

Bulletin: SCDHHS Offers Free Provider Workshops

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

Bulletin: Clarification Bulletin: Long Acting Reversible Contraceptives provided in an Inpatient Hospital Setting

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.

Bulletin: Prior Authorization (PA) for Physician Administered Drugs and Training Schedule with ICORE for Physician Administered Drugs

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.

Bulletin: Rate adjustments

Post Date: 08/08/2013 - 1:49pm

The South Carolina Department of Health and Human Services (SCDHHS) has revised reimbursement rates for the following codes: • 90791 – Psychiatric Diagnostic Evaluation without Medical • 90792 – Psychiatric Diagnostic Evaluation with Medical • 90785 – Interactive Complexity Add-On

Bulletin: SCDHHS Offers Free Provider Workshops

Post Date: 08/05/2013 - 10:34am

Bulletin: Enhanced Physician Payment Reimbursement

Post Date: 07/22/2013 - 12:35pm

The South Carolina Department of Health and Human Services (SCDHHS) recently received final CMS approval for its proposed payment methodology for the Affordable Care Act (ACA) Primary Care Physician rate increase for both the Fee for Service (FFS) and Managed Care Organizations (MCOs). SCDHHS continues its work on this project to ensure that it is implemented accurately, quickly and within the CMS mandates for these enhanced payments.

Bulletin: Application of the Mental Health Parity and Addiction Equity Act (MHPAEA)

Post Date: 07/15/2013 - 9:31am

The South Carolina Department of Health and Human Services (SCDHHS) is issuing this bulletin for guidance on the application of MHPAEA in Medicaid.

Bulletin: CMS National Provider Call July 23: EHR Incentive Program: Overview of EP CQM Beginning 2014

Post Date: 07/10/2013 - 2:05pm

Tuesday, July 23; 1:30-3pm ET This call will give eligible professionals an in-depth overview of clinical quality measures (CQMs) included in the final rule for Stage 2 of Meaningful Use for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program. Details on the measures, the recommended core set for reporting purposes, and the 2014 electronic specifications for the Medicare EHR Incentive Program will be provided. Participants will be given an opportunity to engage CMS subject matter experts with questions on CQMs.

Bulletin: SCDHHS Offers Free Provider Workshops

Post Date: 07/02/2013 - 12:41pm

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.

Bulletin: SCDHHS Hosts Dental Open Forum Follow Up Meeting

Post Date: 06/18/2013 - 9:55am

SCDHHS is hosting a follow up meeting on June 28, 2013 from 10:00 AM to 12:00 PM at the Blue Cross Blue Shield of South Carolina facility at 8901 Farrow Road, Building 200, in Columbia.

Bulletin: South Carolina Medicaid Preferred Drug List

Post Date: 06/17/2013 - 8:38am

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after July 22, 2013.

Bulletin: ADHC Service Rate Increase

Post Date: 06/17/2013 - 8:29am

Effective for services provided on or after July 1, 2013, The South Carolina Department of Health and Human Services (SCDHHS) will increase reimbursement for Adult Day Health Care Services.

Bulletin: SCDHHS Hosts Non-Emergency Medical Transportation Open Forum Follow Up Meeting

Post Date: 06/12/2013 - 3:20pm

The South Carolina Department of Health and Human Services (SCDHHS) hosted Open Forums to receive input on the future of how SCDHHS provides Non-Emergency Medical Transportation (NEMT) services on January 28, 2013 and April 15, 2013.

Bulletin: Health Insurance Premium Payment (HIPP) Program Continues to Cover Monthly Premiums for Eligible Medicaid Beneficiaries

Post Date: 06/11/2013 - 2:44pm

As part of the South Carolina Department of Health and Human Services (SCDHHS) focus on providing the most health for beneficiaries at the least cost to taxpayers, SCDHHS reintroduces its Health Insurance Premium Payment (HIPP) program.

Bulletin: Discount for NCQA's PCMH Recognition Program

Post Date: 06/07/2013 - 11:33am

The South Carolina Department of Health and Human Services (SCDHHS) is a 2013 National Committee for Quality Assurance (NCQA) Recognition Program Sponsor for Patient Centered Medical Homes (PCMH).

Bulletin: Increase in Hours for Nurse Aide Training & Programs New Timeframe Policy for Nurse Aide Program Testing

Post Date: 05/31/2013 - 3:18pm

South Carolina Department of Health and Human Services (SCDHHS) will be making important changes to the South Carolina State-approved Nurse Aide Training Program (NATP) requirements. These changes will be effective as of July 1, 2013.

Bulletin: South Carolina Recovery Audit Contractor

Post Date: 05/17/2013 - 2:55pm

The South Carolina Department of Health and Human Services (SCDHHS) is pleased to announce that Health Management Systems, Inc., (HMS) has been awarded a contract to act as the agency’s Recovery Audit Contractor. Federal regulations (42 CFR 455.500 et. Seq.) require States to establish a recovery audit contract (RAC) program as a measure to promote the integrity of the Medicaid program. HMS previously was the SCDHHS recovery audit contractor and will continue in this role under the new procurement. HMS was founded in 1974 and is a national corporation specializing in healthcare cost containment and program integrity.

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