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Changes to Program Integrity Prepayment Claims Review Policy

Effective April 1, 2019, the South Carolina Department of Health and Human Services (SCDHHS) will amend the Prepayment Claims Review Policy to allow the submission of electronic claims. Unless otherwise specified, claims subject to program integrity prepayment claims review may be submitted electronically. This includes both the claims and the supporting documentation. Providers should carefully review the current manual for compliance with policy guidelines.

This bulletin affects providers participating with Medicaid fee-for-service (FFS) and managed care organizations (MCOs) who are subject to prepayment claims review.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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