Provider Enrollment and Screening



In the Medicaid Bulletin dated May 9, 2012, the South Carolina Department of Health and Human Services (SCDHHS) began the process of addressing provider enrollment regulations published by the Centers for Medicare and Medicaid Services (CMS).  SCDHHS has addressed the CMS regulations and will implement the following on December 3, 2012:


  • Provider Enrollment Manual.  The provider enrollment manual is to be used for provider

information and requirements regarding the Medicaid Provider Enrollment program.  The manual is organized by sections and formatted to give a consistent standardized layout with ease of navigation and readability.  Headings for each subsection appear on the left side of the page with the corresponding information on the right.  The manual is organized as follows:


            Section 1 – General Information and Administration

            Section 2 – Enrollment and Screening Policies

            Section 3 – Program Integrity

            Section 4 – Administrative Services



Please refer to http://provider.scdhhs.govto access the Provider Enrollment Manual.  The website is updated on the first of every month to reflect policy changes to the manual.  Providers with access to the internet should check the SCDHHS website monthly to obtain information about any updates made to the manual.


To order a printed copy of the manual, contact the Provider Service Center at (888) 289-0709.  Charges for printed manuals are based on actual costs of printing and mailing.  The manual is not subject to copyright regulations and may be reproduced in its entirety.


  • Provider Enrollment and Screening Policies.New policies were developed to implement

regulations established by the Affordable Care Act (ACA), emphasizing stronger requirements for Medicaid Provider Enrollment and Screening.  Please visit http://provider.scdhhs.govto review these new policies in the Provider Enrollment Manual.  Below is a list of the Provider Enrollment and Screening polices:


Policy 01-Temporary Moratorium                                    Policy 07-Revalidation of Enrollment

Policy 02-Denial of Enrollment                             Policy 08-License Verification

Policy 03-Provider Termination                            Policy 09-Federal/State Database Check

Policy 04-Ordering/Referring                               Policy 10-Screening of Providers

Policy 05-Credible Allegation of Fraud                 Policy 11-Reactivation of Enrollment

Policy 06-Criminal Background                            Policy 12-Adding Location

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Policy 13-Pre and Post Enrollment Site Visits      Policy 16-Electronic Signature

Policy 14-Application Fee                                     Policy 18-Provider Appeals

Policy 15-Rejection of Enrollment           


Policy 17-Electronic Funds Transfer (EFT) is an agency policy that was implemented on August 26, 2008 and will be enforced and required for enrollment on December 3, 2012.


  • Interactive Web Application.   This application is an automated provider enrollment web-

based application that will enable prospective SC Medicaid providers to utilize a paperless application process.  This new process will ensure the security of providers’ information and is accessible from any computer that has internet access.  The web-based application will enable:


  1. New enrollment for individuals and organizations.
  2. Ordering/referring provider enrollment.
  3. Existing providers to add a new location(s).

Please refer to http://provider.scdhhs.govto accessthe web-based application online.


Effective November 30, 2012, SCDHHS will no longer accept paper applications.  Applications received after this date will be returned to the provider with instructions to enroll utilizing the interactive web application.


  • Application Fee.  SCDHHS will collect the applicable application fee of $523.00 prior to

executing a provider agreement whether upon an initial enrollment, reactivation, revalidation or an enrollment to add a new practice location.  SCDHHS has contracted with SC.Gov Enterprise Payment System to facilitate collection of the application fee.  Payments may be made by debit, credit or e-check.  Paper checks will not be accepted. 


The application fee will apply to:  Business organizations and entities that enroll in South Carolina Medicaid with an Employer Identification Number (EIN).  The application fee does not apply to:


  1. Individual physicians (sole proprietors enrolling with an SSN and EIN are considered individuals)
  2. Non-physician practitioners
  3. Providers who are enrolled in Medicare and/or enrolled in another State’s Medicaid Agency or Children’s Health Insurance Program (CHIP)
  4. Providers who have already paid the applicable application fee to Medicare and/or another State’s Medicaid or CHIP


Additional information is available at http://provider.scdhhs.govin the Provider Enrollment Manual.


  • Pre and Post Site Visits.  SCDHHS will conduct pre-enrollment and post-enrollment site

visits of providers designated as “moderate” or “high” categorical risks to the Medicaid program. 



Private Mental Health Centers

Labs (Portable X-Ray)


Comprehensive Outpatient Rehabilitative Facility (CORF)

Physical Therapist

Community Long Term Care


Private Rehabilitative Behavioral Health



Durable Medical Equipment

Home Health



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Please Note:  Currently enrolled Durable Medical Equipment and Home Health providers are moderate categorical risk level.

The purpose of the site visit is to verify accuracy of the information submitted to SCDHHS and to ensure compliance with Federal and State enrollment requirements.  Any enrolling and/or enrolled provider must permit SCDHHS, its agents or designated contractor, to conduct unannounced on-site inspections of any and all provider locations.  Any enrolling and/or enrolled providers that fail to permit access for site visits will be denied enrollment or terminated from the Medicaid program.   Please refer to the provider enrollment manual at http://provider.scdhhs.govfor additional information.


  • Ordering/Referring Providers.  All ordering/referring providers are required to be enrolled with SC Medicaid if they order and/or refer services for Medicaid beneficiaries. If your ordering/referring provider type is found on the list of SC Medicaid provider types at, you may enroll immediately.


If your ordering/referring provider type is not found on the list of SC Medicaid provider types, SCDHHS will provide future guidance on the next step for enrolling ordering/referring providers.  Residents or interns practicing under the supervision of a licensed professional may utilize the National Provider Identifier (NPI) of the supervising physician on claims as the ordering/referring provider for reimbursement purposes.


Over the next six (6) months, SCDHHS will provide further guidance and instruction relative to provider enrollment for professionals, prescribers and/or providers rendering Medicaid services.  Guidance and instruction will come in the form of a follow-up bulletin.  In the interim, SCDHHS recommends that all individuals providing, prescribing or rendering Medicaid services obtain an NPI which will be required for future provider enrollment.  Providers can apply at their NPI free of charge.

Furthermore, the NPI of the ordering/referring provider or other professional must be included on any Medicaid claim for payment based on an order or referral from that physician or other professional.  For paper and electronic claims, providers can reference the following table:


Claim Form

Field Number

Field Name

Special Note

CMS-1500 (08/05)


Name of Referring Provider or Other Source

Enter the name of Referring or Ordering Provider




Enter the NPI of Referring or Ordering Provider
















Enter the NPI of Referring or Ordering Provider


Enter the Last Name of Referring or Ordering Provider


Enter the First Name of Referring or Ordering Provider







Referring Provider

Enter the NPI of Referring or Ordering Provider



Referring Provider

Enter the NPI of Referring or Ordering Provider

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Providers may refer to the South Carolina Companion Guides online at http://provider.scdhhs.govfor additional information regarding placement of the ordering or referring NPI on electronic claims.


  • Provider Policy Manual.  SCDHHS has been sending a CD copy of the manualwith each new enrollment, but it is not required.  Therefore, we will discontinue the practice with enrollments received on or after December 3, 2012.  Please visit http://provider.scdhhs.govto viewthe Provider Policy Manual.


The web site is updated on the first of every month to reflect policy changes to the manual.  Providers with access to the internet should check the SCDHHS website monthly to access updates to the manual.


To order a printed copy of the manual, contact the Provider Service Center at (888) 289-0709.  Charges for printed manuals are based on actual costs of printing and mailing.  The manual is not subject to copyright regulations and may be reproduced in its entirety.


SCDHHS’ goal is to continue to enhance the integrity of the Medicaid program while streamlining the enrollment process and complying with federal requirements.  Currently enrolled Medicaid providers do not have to re-enroll or re-validate their existing enrollment at this time.  Providers, including ordering/referring, enrolled or reactivated on or after December 3, 2012, will be screened according to the new provider enrollment and screening regulations.


If you have any questions regarding the provider enrollment and screening regulations, please contact the Provider Service Center at (888) 289-0709, Option 4. To review Frequently Asked Questions, please visit http://provider.scdhhs.govon our website.  Thank you for your continued support of the South Carolina Medicaid program.

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