Access to Records Concerning Medicaid Services and Payment

PROVIDER ALERT

This is a reminder that, as a condition of participation in the Healthy Connections Medicaid program, providers are required to maintain and provide access to records. These records should fully disclose the medical necessity for treatment and the extent of services provided to Medicaid beneficiaries. Unless program policy otherwise allows, this documentation must be present in the beneficiaries' records before the provider files claims for reimbursement. For the purpose of reviewing and reproducing documents, providers shall grant to staff of the South Carolina Department of Health and Human Services (SCDHHS), the State Auditor's Office, the South Carolina Attorney General's Office, the Government Accountability Office (GAO), the U.S. Department of Health and Human Services (USDHHS) and/or any of their designees access to all records concerning Medicaid services and payment. These records may be reviewed during normal business hours, with or without notice. [SSA Section 1902(a)(27); 42 CFR 431.107(b)(2); Provider Manual Section 1.]

Under this rule, the Agency expects to be granted access to all records concerning Medicaid services and payment immediately upon request. Pursuant to Section 2 of the Provider Enrollment/Screening Policies Manual, SCDHHS has the authority to terminate a provider who fails to provide access to Medicaid patient records. The Agency intends to exercise this authority for providers who fail to provide access to Medicaid patient records.

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

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