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Medicaid Policy Manual for Autism Spectrum Disorder

May 1, 2017 - The South Carolina Department of Health and Human Services (SCDHHS) released the new Medicaid Autism Spectrum Disorder (ASD) Provider Manual. This manual is effective July 1, 2017, and is to be used for program information and requirements, billing procedures and provider services guidelines. Providers should carefully review this manual in order to be compliant with policy guidelines.

The manual is organized as follows, with each section having its own table of contents:

  • Section 1, General Information and Administration, contains an overview of the South Carolina Medicaid program, as well as information about record retention, documentation requirements, utilization review, program integrity and other general Medicaid policies.
  • Section 2, Policies and Procedures, describes policies and procedures specific to the ASD program.
  • Section 3, Billing Procedures, contains billing information that is common to all South Carolina Medicaid programs, as well as program-specific guidelines for claim filing and processing.
  • Section 4, Procedure Codes, contains procedure codes, other approval codes and modifiers.
  • Section 5, Administrative Services, contains available SCDHHS resources for providers and claim form suppliers and vendors.

The Forms section includes forms and form samples referenced throughout the manual, as well as some generic forms.

The Appendices include the following:

  • Appendix 1: Edit Codes, CARCs & RARCs and Resolutions.
  • Appendix 2: Carrier Codes.
  • Appendix 3: Schedule of Copayments.

The Third-Party Liability Supplement explains third-party liability requirements and recommended practices. It includes sample forms and resources.

The Managed Care Supplement contains information on the managed care program, including pictures of the cards issued by the various managed care plans.

The most current version of the provider manual is maintained on the SCDHHS website. From the SCDHHS home page navigation, select “For Providers,” then select “Provider Manuals.” The online provider manuals are updated on the first of every month to reflect any minor non-policy changes to provider manuals (e.g., corrections to addresses, etc.).

SCDHHS policy changes are communicated to providers through Medicaid bulletins; manuals are revised to reflect those changes. Providers may subscribe to receive Medicaid bulletins on the SCDHHS website. Providers with access to the internet should check the SCDHHS website monthly to access information about any updates made to the provider manuals.

Should you wish to order a printed copy of your provider manual, please call the SCDHHS Provider Service Center at 1 (888) 289-0709. Charges for printed manuals are based on actual costs of printing and mailing.

If you have any questions regarding this provider manual, please contact the SCDHHS Provider Service Center at 1 (888) 289-0709.

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

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