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Post date: 05/16/2012 - 10:27am

Effective June 1, 2012, KePRO will begin operations as the QIO for the South Carolina Department of Health and Human Services (SCDHHS), Medicaid. KePRO will be responsible for prior authorization (PA) of services as well as pre-payment and/or medical record review of select services. Patients with Medicare as primary payor are only required to obtain a PA if Medicare does not make a payment or the service is not covered by Medicare and Medicaid then becomes primary. Please note that Managed Care Organizations will continue to authorize services according to their specific plans for enrolled beneficiaries (members). Case Managers and Service Coordinators for CLTC and DDSN home and community-based waiver programs will continue to authorize services for their waiver participants.

Post date: 05/09/2012 - 1:19pm

The South Carolina Department of Health and Human Services (SCDHHS) will be implementing new provider enrollment and screening regulations published by the Centers for Medicare and Medicaid Services (CMS).

Post date: 05/09/2012 - 10:15am

The public comment period closes on Wednesday, May 16th at 5:00 PM Eastern. Please visit the SCDuE web site (https://msp.scdhhs.gov/scdue/) to download the proposal. Two of three consumer-focused public meetings remain. These two meetings are scheduled for Wednesday, May 9th in Columbia and Friday, May 11th in North Charleston. Please submit Letters of Support by Wednesday, May 23rd.

Post date: 05/07/2012 - 11:08am

COLUMBIA, S.C. — The South Carolina Department of Health and Human Services (SCDHHS) announced Monday that it has joined forces with several of the nation’s largest employers and other health care purchasers in an initiative to create more value in today’s health care system by improving how health care providers are paid.

Post date: 05/03/2012 - 4:40pm

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: 04/26/2012 - 1:39pm

Fragile households seeking solid footing in a weak economy will receive reinvigorated support as Colorado, Idaho, Illinois, North Carolina, Rhode Island, and South Carolina take up the challenge of streamlining services aiding low-income working families. The six states have been awarded three-year grants to test and implement easy-to-navigate, quick-to-deliver public benefit systems. The grants, the centerpiece of the Work Support Strategies: Streamlining Access, Strengthening Families (WSS) initiative, average about $460,000 per state for each year.

Post date: 04/19/2012 - 12:35pm

Post date: 04/19/2012 - 8:39am

Last week, the South Carolina Department of Health and Human Services (SCDHHS) discovered that a Medicaid employee inappropriately transferred personal information for 228,435 Medicaid beneficiaries to his personal email account, constituting a violation of agency policy.

Post date: 04/17/2012 - 9:27am

The South Carolina Department of Health and Human Services (SCDHHS) will co-sponsor provider/facility training with Keystone Peer Review Organization, Inc. (KePRO), the new QIO for Medicaid. KePRO will offer 4 regional trainings with morning sessions designated for facility staff. Afternoon sessions are designated for physicians and other medical professionals.

Post date: 04/12/2012 - 8:04pm

COLUMBIA, S.C. — Several state agencies are working with law enforcement to ensure the health and safety of residents of a North Charleston assisted living facility closed on Thursday by police. The closing comes after the owner of Fair Havens Manor on Cosgrove Avenue was arrested by North Charleston police Thursday morning. She is accused of neglecting the residents at the community residential care facility (CRCF), which was home to 15 vulnerable adults.

Post date: 04/12/2012 - 3:14pm

South Carolina Department of Health and Human Services (SCDHHS) is clarifying that pregnant women applying for Medicaid under Optional Coverage for Pregnant Women and Infants (OCWI) may enter the program under assumptive eligibility provisions. If a woman declares that she is pregnant, and submits an application, she can be determined Medicaid eligible based on her attestation of income, resources, and citizenship for a 30-day period, while she is given the opportunity to return the necessary verification to determine continued eligibility.

Post date: 04/12/2012 - 2:19pm

Effective March 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) began implementation of a contract with the Keystone Peer Review Organization, Inc. (KePRO), to serve as the new Quality Improvement Organization with an operational date of June 1, 2012.

Post date: 04/09/2012 - 11:46am

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: 03/28/2012 - 10:30am

The South Carolina Department of Health and Human Services (SCDHHS) is pleased to announce its new web page dedicated to information related to the implementation of the International Classification of Diseases Version 10 (ICD-10), with a mandatory compliance date of October 1, 2013.

Post date: 03/21/2012 - 1:59pm

The South Carolina Department of Health and Human Services (SCDHHS) is offering training to Medicaid enrolled Federally Qualified Health Clinics, Rural Health Clinics, Family Practice, and OB/GYN providers on Screening, Brief Intervention, and Referral to Treatment (SBIRT). SBIRT is an agency initiative, in partnership with other stakeholders, to help identify and offer treatment to pregnant beneficiaries who may have alcohol or other /substance dependence, depression, or domestic violence.

Post date: 03/13/2012 - 5:05pm

Today I'm pleased to announce that Deirdra Singleton has accepted the new position of Chief of Staff at SCDHHS beginning immediately. Deirdra skillfully served as the Department's General Counsel since 2000, and joined SCDHHS as an Administrative Hearing Officer in 1988. She earned her bachelor's degree from the University of South Carolina and her law degree from the University of South Carolina School of Law. Her duties as General Counsel included advising senior management on key legal and regulatory issues and overseeing several critical Department areas, including the Office of General Counsel, Program Integrity and Internal Audits, Legislative Affairs and Communications and Reporting, Research and Special Projects .

Tags: Leadership
Post date: 03/12/2012 - 10:26am

The South Carolina Department of Health and Human Services (SCDHHS) is in the process of submitting a State Plan Amendment (SPA) for Targeted Case Management (TCM) to the Centers for Medicare and Medicaid Services (CMS). SCDHHS is providing the following updates to the public:

Post date: 03/09/2012 - 3:52pm

Effective with dates of services on or after April 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will make the following policy updates.

Post date: 03/09/2012 - 3:49pm

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after April 9, 2012

Post date: 03/09/2012 - 3:45pm

Join CMS for a National Provider Call on the Proposed Rule for Stage 2 Join CMS is holding a National Provider Call on Monday, March 12, from 12:30 – 2:00 pm ET for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) to provide an overview of the proposed rule for Stage 2 for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.

Post date: 03/02/2012 - 11:13am

Effective with dates of service on or after April 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will expand coverage of nursing home admission or swing-bed placement from the initial thirty (30) days of continuous confinement to ninety (90) days of continuous confinement as part of the Managed Care Organization (MCO) covered responsibilities. Providers will be required to file claims to the MCOs for MCO enrolled beneficiaries.

Post date: 03/01/2012 - 3:09pm

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

Post date: 02/15/2012 - 12:18pm

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

Post date: 02/07/2012 - 4:49pm

Effective February 21, 2012, LogistiCare Solutions, LLC will begin covering the two (2) regions currently operated by Access2Care. At that time LogistiCare will be responsible for all three (3) South Carolina Non-Emergency Medical Transportation (NEMT) regions in the state.

Post date: 02/02/2012 - 10:22am

Effective April 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will be including the professional and outpatient facility charges associated with Medicaid covered behavioral health services as part of the Managed Care Organization (MCO) covered responsibilities. Providers will be required to file claims for behavioral health services to the MCOs for MCO enrolled beneficiaries. Providers must verify eligibility and contact the applicable MCO for prior authorization before rendering services.

Post date: 01/19/2012 - 5:02pm

Effective for dates of services on or after March 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) is updating its policy to include reimbursement for long acting birth control devices provided in a hospital setting. The coverage of this service will be considered an add-on benefit and will not be included in the Diagnostic Related Group (DRG) reimbursement system.

Post date: 01/17/2012 - 1:42pm

COLUMBIA, SC— Physicians, hospitals and state agencies will work to improve the health outcomes of thousands of babies by helping pregnant women receiving Medicaid seek treatment for substance abuse, depression and domestic violence, the South Carolina Department of Health and Human Services (SCDHHS) announced Tuesday. The SBIRT program is part of SCDHHS’ Birth Outcomes Initiative, which works with hospitals and other partners to improve the health of newborns in the Medicaid program and is a component of Gov. Nikki R. Haley’s overall strategy to support investments in mental health and addiction disorders statewide.

Post date: 01/13/2012 - 3:40pm

COLUMBIA, S.C. — Today South Carolina Department of Health and Human Services Director Anthony Keck announced several actions to reduce eligibility determination errors which a recently released federal audit indicates may have resulted in a total of $406 million of improper Medicaid payments during federal fiscal year (FFY) October 2009 to September 2010.

Post date: 01/12/2012 - 2:27pm

American Medical Response, Incorporated, operating as Access2Care in South Carolina, has terminated their contract with South Carolina Department of Health and Human Services (SCDHHS) for the Non-Emergency Medical Transportation Program (NEMT). Effective December 22, 2011, Access2Care began its 60-day transition plan to exit the state by February 21, 2012.

Post date: 01/11/2012 - 4:23pm

Effective with dates of service on or after February 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will cover Tobacco Cessation treatment for all pregnant women in accordance with Section 4107 of the Affordable Care Act, which amended Section 1905 (bb)(2) of the Social Security Act. For the complete policy and billing instructions, please review the Physician, Laboratories and Other Medical Professionals manual located on the SCDHHS website at www.scdhhs.gov.

Post date: 01/11/2012 - 4:20pm

Post date: 01/07/2012 - 1:24pm

SCDHHS has received inquiries regarding an unusually high number of suspended claims that appear on the January 6, 2012 Remittance Advice (RA).

Post date: 01/05/2012 - 4:21pm

Post date: 12/30/2011 - 9:07am

The South Carolina Department of Health and Human Services (SCDHHS) will begin processing 5010 transactions January 1, 2012, as mandated. On November 17, 2011, the Centers for Medicare and Medicaid Services (CMS) announced a 90-day delay in enforcement of the new 5010 transactions standards. Although enforcement of compliance to ASC X12 5010 Version 5010 and NCPDP D.0 was delayed until March 31, 2012, the mandatory compliance date remains January 1, 2012.

Post date: 12/29/2011 - 10:34am

The South Carolina Department of Health and Human Services (SCDHHS) has determined that payments for CMS1500 claims received December 22 through December 26, 2011 and reflected on the provider remittance advice for payment dated December 30, 2011, were not processed correctly. The 308 edit (invalid procedure code modifier) was erroneously assigned to claims due to a system problem.

Post date: 12/08/2011 - 3:18pm

Post date: 12/08/2011 - 3:14pm

FREQUENCY LIMITATION APPLICATION With the transition to DentaQuest (DQ), the South Carolina Department of Health and Human Services (SCDHHS) made changes to the frequencies allowed for certain dental services. These changes were communicated in a Provider Bulletin dated October 15, 2010. Providers should review the latest version of the Dental Office Reference Manual (ORM) to verify frequency limits and to check the web portal to determine if the beneficiary has received the service within the frequency time period. Failure to follow the frequency limits in the ORM may result in the denial of the claim. The ORM contains SCDHHS policies applicable to the administration of the dental program. It is advised that providers maintain a copy of the claims history in the patient record until the claim has paid.

Post date: 11/18/2011 - 2:53pm

II. Modification to Prior Authorization (PA) Requirements for Organ Transplants III. Delivery in Cases of Prolonged Labor

Post date: 11/18/2011 - 2:46pm

Effective December 31, 2011, the South Carolina Department of Health and Human Services’ (SCDHHS) toll free eligibility verification line (1-888-809-3040) will no longer be available. This system is currently used by a small number of providers to validate member eligibility and/or to check the status of the most recent payment from SCDHHS. Providers may access this same information via the free SCDHHS Web Tool.

Post date: 11/04/2011 - 4:30pm

The South Carolina Department of Health and Human Services (SCDHHS) is excited to announce the launch of its newly designed public website on Monday, Nov. 7, 2011.

Post date: 11/03/2011 - 11:03am

Effective with dates of service on or after December 1, 2011, the South Carolina Department of Health and Human Services (SCDHHS) will implement limitations on Alcohol and Drug Screens. For the complete policy and billing instructions, please see the Physician, Laboratories and Other Medical Professionals manual located at www.scdhhs.gov.

Post date: 11/03/2011 - 10:58am

Effective for claims with discharge dates on or after November 1, 2011, the South Carolina Department of Health and Human Services (SCDHHS) has revised the policy for patients eligible for Administrative Days. This revision removes all references to the 50-mile limit for Nursing Home placements. The revised policy will read:

Post date: 10/17/2011 - 11:16am

Effective For Dates Of Service On Or After October 15, 2011, 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%

Post date: 10/17/2011 - 11:15am

Exemption To The Waiting List For Community Long Term Care (CLTC) Community Choices Waiver

Post date: 10/17/2011 - 11:13am

Effective November 1, 2011, the Medicaid Insurance Verification Services (MIVS) contract will no longer be administered by Affiliated Computer Services, Inc. Blue Cross Blue Shield of South Carolina (BCBSSC) will be performing the following services on behalf of the South Carolina Department of Health and Human Services (SCDHHS):

Post date: 10/17/2011 - 11:12am

Columbia, S.C. - Forty-Two Of 43 Hospitals That Deliver Babies In South Carolina Have Signed A Pledge To End The Practice Of Harmful Elective Deliveries Prior To 39 Weeks For Pregnant Medicaid Enrollees, The South Carolina Department Of Health And Human Services (SCDHHS) Announced Thursday.

Post date: 10/13/2011 - 2:50pm

October 2011 Bulletin Archive

Post date: 09/23/2011 - 2:49pm

September 2011 Bulletin Archive

Post date: 08/30/2011 - 2:48pm

August 2011 Bulletin Archive

Post date: 08/30/2011 - 1:41pm

The Patient Protection and Affordable Care Act ((H.R. 3590) Section 6507 (Mandatory State Use of National Correct Coding Initiative (NCCI)) requires State Medicaid programs to incorporate "NCCI methodologies" in their claims processing systems by October 1, 2010.

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