Looking for an update on the status of your Medicaid application or Annual Reviews?
If you would like an update as to the status of your Medicaid application, submit documentation for an application or Annual Review, or have a question unrelated to filing an appeal, click below to contact the Member Service Center.
The Office of Appeals and Hearing's impartial hearing officers conduct fair hearings and issue written decisions. This page provides access to information about how to appeal, what to expect after you appeal, and what to expect at a hearing.
The SCDHHS Office of Appeals and Hearings oversees the fair hearing process filed by either an applicant, member, or provider from an adverse agency decision.
An SCDHHS appeal is not a records review. When you file an appeal, you are requesting an in-person hearing before a Hearing Officer. To learn more about the appeals process, please read Appeals Hearings 101 or view Appeals and Hearings FAQs.
Once you request an appeal, the Office of Appeals and Hearings staff may contact you asking for additional information before it can be opened and assigned to a Hearing Officer.
If you are looking for an update on a pending application or need to submit documentation related to your annual eligibility review, you can check your annual review status or upload documentation at apply.scdhhs.gov. If you have a general question about your annual eligibility review status, call the Member Contact Center at 888-549-0820 from 8 a.m. to 6 p.m., Monday - Friday, or email firstname.lastname@example.org.
If you are a provider filing for fee-for-service claim reconsideration, please click below.
- Fee-for-Service Provider Claim Reconsideration
If a participating provider does not agree with the decision of a processed claim, the provider will have 30 calendar days from the date the adverse action, denial of payment, remittance advice or initial review determination to submit a reconsideration. The request should include an explanation of the provider’s disagreement with the decision made by SCDHHS.
If a provider believes a claim was processed incorrectly due to incomplete, incorrect or unclear information on the claim, the provider should submit a corrected claim. Do not file a reconsideration. Corrected claims should not be submitted as part of a reconsideration.
If the outcome of the claim reconsideration is adverse to a provider, SCDHHS will provide a determination letter upholding the original decision. The letter will state that the provider may request an appeal. If an appeal is approved, the payment will appear on the provider’s remittance advice. Appeals may be reviewed by the SCDHHS appeals staff, medical directors, claim staff, provider relations staff and any department with reason to assist in resolving a complaint or appeal.
For any questions regarding SCDHHS’ processes, please contact the Provider Service Center at 1 (888) 289-0709 Monday through Thursday, 7:30 a.m. to 5 p.m. and 8:30 a.m. to 5 p.m. Friday, Eastern Standard Time (EST).
We welcome your feedback about your experience with the appeals process and hearing officers. Please tell us about your experience - How Did We Do?
Please contact us if you have any questions.