Modification To Codes That Require Filing To Third-Party Insurers

Effective for dates of service on or after Jan. 1, 2017, and as required by federal regulation, the South Carolina Department of Health and Human Services (SCDHHS) will implement cost-avoidance rules for the procedure codes reflected below. Service providers will be required to file the claim to any third-party insurer before the claim submission to SCDHHS for payment. Claims filed with SCDHHS with the procedure codes reflected below, before billing all third-party insurers, will receive all applicable claim edits. Resolution of applicable claim edits for the issue described above is outlined in the appendices of each SCDHHS provider manual located at https://www.scdhhs.gov/provider-manual-list .

Please refer any questions or concerns regarding this bulletin to the Provider Service Center at (888) 289-0709.

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