Deemed Baby Process

PROVIDER ALERT

The South Carolina Department of Health and Human Services (SCDHHS) implemented a new eligibility system in November. Throughout the launch, SCDHHS worked diligently to ensure the Agency provided timely and accurate eligibility determinations.  

During the system changeover, there was a delay in the completion of final determinations. SCDHHS continues to process applications and aims to be completely in the new system, resuming standard eligibility determination turnaround times, in the next few weeks. 

The conversion to the new system has impacted the deemed baby process. To assist providers and to ensure that newborns are served timely, SCDHHS wants to remind providers that the current policy and procedures remain in place. If a child has been born to a Medicaid-eligible mother and eligibility has been verified for the mother, then the child will be deemed eligible for Healthy Connections Medicaid as a result of the mother’s eligibility. This includes mothers eligible for Emergency Services only

SCDHHS encourages all providers to continue to deliver medically-necessary services to newborns prior to obtaining their Medicaid identification numbers in all cases where the mother is currently Medicaid eligible. Billing for these procedures can be held until such time as the newborn identification is obtained. SCDHHS estimates the newborns to be deemed backlog will be resolved within the next 30 days.

If the infant does not have a Medicaid Identification number, claims for well care only from the ‘Professional’ side can be billed under the mother’s Healthy Connections Medicaid identification number. This mechanism may provide quicker claims payment, if utilized.    

As part of the system upgrade, SCDHHS revised the form that providers submit to obtain a Medicaid number for eligible newborns (DHHS Form 1716 ME). To access the revised form, Form 1716 ME: Request for Medicaid ID # - Newborns, please visit scdhhs.gov/sites/default/files/FM%201716%20ME.pdf.

If you have any questions, please contact the Provider Service Center at (888) 289-0709. 

Thank you for your continued support as SCDHHS works to improve the Medicaid process and system for Healthy Connections members and providers.

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