Enhanced Physician Payment Schedule Adjustment



The South Carolina Department of Health and Human Services (SCDHHS) informed providers in a Medicaid bulletin dated March 26, 2013 that any provider eligible for the ACA enhanced physician payment would receive an adjusted payment on their remittance advice dated May 17, 2013, for claims processed from January 1, 2013 through April 19, 2013.  All claims with dates of service on or after April 20, 2013 would include the enhanced payment as claims were processed via the regular claims processing schedule.  The Centers for Medicare and Medicaid Services (CMS) has informed SCDHHS that the State Plan amendment must be approved before these enhanced payments can be made.  Along with most states, SCDHHS is awaiting CMS approval and therefore cannot make payments for this program.

Once CMS approval is received, SCDHHS will implement payments to providers via the regular Fee-for-Service (FFS) claims payment schedule for services delivered after the CMS approval date.

CMS is also currently reviewing the enhanced payment methodology for managed care.  Originally, SCDHHS had estimated that enhanced payment for claims filed with dates of service from January 1, 2013 to March 31, 2013 would be made to Managed Care Organizations (MCOs) at the end of June, 2013.  This time frame for payment is predicated on when CMS will approve the State’s current payment methodology.  If CMS approval is not received in time for payment on its current proposed schedule, SCDHHS will make the first quarterly payments soon after CMS has approved the payment methodology.

We apologize for any inconvenience the payment delay will cause.  However, SCDHHS must adhere to evolving CMS guidelines relating to this program’s implementation.

This bulletin applies to FFS, Medical Homes Networks (MHNs) and MCOs.  Please visit www.scdhhs.govfor more details on the Enhanced Physician Payments, including bulletins and frequently asked questions.  If you have any questions regarding this bulletin, please contact the Provider Service Center at (888) 289-0709.  Thank you for your continued support of the South Carolina Medicaid Program.

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