Federal law requires all providers who order, refer or prescribe services or items for Medicaid members to be enrolled in that state’s Medicaid program—even if they don’t bill Medicaid directly. This is part of a federal rule (42 CFR § 455.410) from the Patient Protection and Affordable Care Act (ACA).

Effective immediately, providers who order, refer or prescribe items or services for Healthy Connections Medicaid members must enroll with the South Carolina Department of Health and Human Services (SCDHHS) as Healthy Connections Medicaid providers regardless of whether they submit claims for these items or services. This applies to providers who currently order, refer or prescribe items or services for Healthy Connections Medicaid members and to providers who anticipate they may in the future. 

Providers may enroll through SCDHHS’ website here. Providers should select the “Ordering/Referring” provider type when enrolling. Providers who are only enrolling as an Ordering/Referring provider only need to enroll with SCDHHS and do not need to contract with the state’s managed care organizations. Physicians and other providers who are already enrolled in Healthy Connections Medicaid and who submit claims to Medicaid are not required to enroll separately as ORP-only providers. SCDHHS has published a list of frequently asked questions and enrollment guidance for Ordering/Referring providers on the new ORP section of its website.

SCDHHS will provide additional guidance and resources as it continues to support Healthy Connections Medicaid providers’ compliance with these federal requirements.

Providers should direct any questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Providers can also submit an online inquiry at https://www.scdhhs.gov/providers/contact-provider-representative.

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