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Provider Enrollment and Screening Requirements

 

  • Be licensed by the appropriate licensing body, certified by the standard-setting agency, and/or other pre-contractual approval processes established by South Carolina Department of Health and Human Services (SCDHHS).
  • Continuously meet South Carolina licensure and/or certification requirements of their respective professions or boards in order to maintain Medicaid enrollment.
  • Comply with all federal and state laws and regulations currently in effect as well as all policies, procedures, and standards required by the Medicaid program.
  • If eligible, obtain a National Provider Identifier (NPI) and share it with South Carolina Medicaid. Refer to https://nppes.cms.hhs.gov for additional information about obtaining an NPI.
  • Be enrolled in the South Carolina Medicaid program and receive official notification of enrollment.

 

PROVIDER ENROLLMENT PROCESS

The enrollment process includes screening, licensure verification and site visits (if applicable), to ensure that all enrolling providers are in good standing and meet the requirements for which they are seeking enrollment.  Refer to http://provider.scdhhs.gov  for the eligible provider listing of SC Medicaid provider types and specialties.

Once the provider has been approved for Medicaid enrollment, official notification of enrollment will be sent to the provider.

 

ONLINE ENROLLMENT APPLICATION

 

You can enroll using the online application.  This process will ensure the security of providers’ information and is accessible from any computer that has internet access.  The web-based application will enable:

 

  1. New enrollment for individuals and organizations.
  2. Ordering/referring provider enrollment.
  3. Add a new location(s) to an existing enrollment

 

Once you have completed minimal required information, you will receive a Reference ID#.  Use this Reference ID# to retrieve and complete an in-process application. The in-process application must be submitted within 30 days.  After 30 days, the in-process application will be purged and you must start the enrollment process over and be assigned another Reference ID#.

 

Complete an online provider enrollment application and agreement and submit any necessary supporting documentation to Provider Enrollment via fax at 803-870-9022. Indicate Reference ID# on all supporting documentation and/or communication in reference to the submitted application.  Certain provider types, depending on the type of service provided, will be notified if the provider is required to sign a contractual agreement in addition to the provider enrollment agreement. 

Accept the terms and conditions of the online application by electronic signature, indicating the provider’s agreement to the contents of the participation agreement, the Electronic Funds Transfer Agreement, W-9 and Trading Partner Agreement. 

Refer to http://provider.scdhhs.gov to access the Online Enrollment Application Introduction Video (1 minute)and the Online Enrollment Application Visual Guide.

To access the online application, click this link: https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/

 

APPLICATION FEE and PAYMENT

 

SCDHHS will collect the 2014 application fee of $542.00 prior to executing a provider agreement whether upon an initial enrollment, reactivation, revalidation or an enrollment to add a new practice location.  [Note:  $532.00 for 2013]  The application fee applies to business organizations and entities that enroll in South Carolina Medicaid with an Employer Identification Number (EIN) that intends to bill on a fee-for-service basis for a new practice location in a different enrollment jurisdiction or as a new provider type. A different enrollment jurisdiction means “a new enrollment with an address different from a currently enrolled location.”

The application fee does not apply to: Individual physicians (sole proprietors enrolling with an SSN and EIN are considered individuals), non-physician practitioners, providers who are enrolled in Medicare and/or enrolled in another State’s Medicaid Agency or Children’s Health Insurance Program (CHIP) and providers who have already paid the applicable application fee to Medicare and/or another State’s Medicaid or CHIP.  SCDHHS has contracted with SC.Gov Enterprise Payment System to facilitate collection of the application fee.  Payments may be made online by electronic check, credit card or by debit from your checking or savings account.  Visa, MasterCard, American Express and Discover are acceptable.  Paper checks will not be accepted.  

 

To make a payment, click this link: https://ssl.sc.gov/Checkout/DHHS/

Web Application System Requirements

The interactive web application works with the following:

Internet Explorer: Version 8, Version 9

Firefox: Version 13, Version 14, Version 15,Version 16

Chrome: Version 23.0.1271.64

Safari: Version 6.0.1

When accessing the web application, if either of the two following situations occurs, you will need to make adjustments to your internet browser environment.

  • You correctly enter your NPI and you receive a display message that the NPI is not valid.  The first time you may encounter this situation is when you are entering your Individual or Organization information.  If you do not encounter this situation until later in the application, please verify that the NPI has been entered correctly. 

 

  • Your view of the page shows an excessive amount of spacing between entry fields requiring an unusual amount of page scrolling.  If you encounter this situation, it will occur after you select “Begin a New Enrollment”.  The next page displayed will require you to select either “New Enrollment” or “Add a Location”.  When you select either button, the “Enroll Now” button in the bottom right hand corner should not disappear from your immediate page view.  If the “Enroll Now” button is not viewable without scrolling, you will need to complete the steps listed below to solve the problem.

  

The issue causing either of these situations is the “compatibility view” settings of your internet browser. Completing the following steps will allow you to use the Provider Enrollment web application in the manner intended.

  1. Close your current web application by selecting “Exit Enrollment” in the upper right hand corner of the application.
  2. Select “OK” to the pop-up message advising you that you will be exiting the application and any entered data will be lost.
  3. In the Menu bar of your internet browser, select “Tools”.
  4. Selecting “Tools” will display a drop-down list of your browser settings.
  5. In the drop-down list, select the “Compatibility View Settings” entry. 
  6. Confirm that “scdhhs.govdoes not appear in the text box labeled “Websites you’ve added to Compatibility View”. 
  7. Should the entry appear in the text box, click on the “scdhhs.gov” entry.
  8. Click the “Remove” button.
  9. Confirm “”scdhhs.gov” is removed from the text box.
  10. Select “Close” to close the window.
  11. You are now ready to once again begin your new enrollment application.

 

QUESTIONS

If you have questions, contact the South Carolina Provider Service Center at

888-289-0709, Option 4 or visit http://provider.scdhhs.gov to submit an e-Inquiry by clicking on the CONTACT A PROVIDER REPRESENTATIVE hyperlink.

 

FOR MORE INFORMATION

Visit http://provider.scdhhs.gov