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Reminder: Changes to Third-Party Liability Policy


On Dec. 16, 2021, the South Carolina Department of Health and Human Services (SCDHHS) issued Medicaid bulletin MB# 21-016 with an update on changes to the claims processing policy as it relates to third-party liability (TPL). These changes, which took effect Dec. 31, 2021, were made to comply with federal requirements established by the Bipartisan Budget Act of 2018 and Medicaid Services Investment and Accountability Act of 2019.

SCDHHS is issuing this bulletin to remind providers of these changes including:

  • The requirement for states to apply cost avoidance procedures to claims for prenatal services, including labor, delivery and postpartum care services; and
  • For claims related to child support enforcement beneficiaries, SCDHHS will apply cost avoidance for 100 days after the date the provider has submitted a claim to the entity that has primary liability for payment. After the 100 days have elapsed, SCDHHS will make payments without regard to potential TPL.
    Providers with questions regarding this bulletin should contact the SCDHHS Provider Service Center (PSC) at (888) 289-0709. The PSC’s hours of operation are 7:30 a.m. to 5 p.m. Monday through Thursday and 8:30 a.m. to 5 p.m. Friday.

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

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