Eligibility and Claims Inquiries from Providers

PROVIDER ALERT
CORRECTION: The original alert titled "Eligibility and Claims Inquiries from Providers" that was issued on March 22, 2021, erroneously stated that the Provider Service Center (PSC) is open on Fridays from 8 a.m.- 5 p.m. The alert should have stated that the PSC is open on Fridays from 8:30 a.m. – 5 p.m. We apologize for any confusion resulting from the original alert. 
 
Set out below is the corrected alert in its entirety.
 

The South Carolina Department of Health and Human Services (SCDHHS) is updating guidance on how providers should submit requests and inquiries related to Medicaid eligibility. The Eligibility Administrative Support Team (EAST) will no longer process inquiries via its fax or email address. Effective immediately, all provider updates and inquiries should only be submitted via the procedures outlined below.

Request for Medicaid ID Number of Newborn (DHHS Form 1716)

Requests for newborn Medicaid IDs must be submitted to SCDHHS’ central document management team via DHHS Form 1716 via:

  • Mail at: SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202; or,
  • Toll-Free Fax at:  1-888-820-1204
  • Note:Please send a separate fax for each applicant/member to expedite processing.

Medicaid Member Address Corrections

Requests for member address corrections should be made by the Healthy Connections Medicaid member, not their healthcare provider. Requests can be made by calling the Healthy Connections Member Contact Center toll free at 1-888-549-0820 from 8 a.m.-6 p.m., Monday-Friday. EAST will no longer process requests for Healthy Connections Medicaid member address changes.

Retroactive Claim Requests (DHHS Form 945)

For retroactive claim requests with a date of service of more than nine months ago, ( DHHS Form 945 ), providers should contact the Provider Service Center at 1-888-289-0709. The Provider Service Center’s hours of operations are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. on Friday.

Claims Inquiries

All questions regarding claim payments must be submitted through the Provider Service Center. The Provider Service Center has escalation procedures in place to ensure claims issues are escalated appropriately. Providers will receive a reference number to track ongoing inquiries for their specific claim.

Verifying Eligibility for Enrolled Members

Providers can access information online to help determine if an individual is enrolled in Medicaid through the South Carolina Medicaid Web Portal, commonly known as the “web tool.” To access the web tool, please visit https://portal.scmedicaid.com/login . Providers may also contact the Provider Service Center to verify eligibility. Providers are not required to have a completed Authorized Representative agreement ( DHHS Form 1282 ) on file to submit an enrollment inquiry via the web tool.

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

Tags: 
Report Fraud