Individuals with Disabilities Education Act Part C Program (BabyNet) Updates

PROVIDER ALERT

The South Carolina Department of Health and Human Services (SCDHHS) is continuing to integrate the Individuals with Disabilities Education Act (IDEA) Part C program, commonly known as BabyNet in South Carolina, and Healthy Connections Medicaid program. This includes integrating the two programs’ respective systems, the BabyNet Reporting & Intervention Data Gathering Electronic System (BRIDGES) and the Medicaid Management Information System (MMIS).

SCDHHS has received feedback from providers regarding edits that have been generated through the integration of BRIDGES and MMIS. Most edits are routine functions of MMIS put in place to enforce program business rules and requirements. Providers should contact SCDHHS’ Provider Service Center (PSC) with questions regarding claims edits instead of emailing or calling the BabyNet state office. Directing questions to the PSC, SCDHHS’ main provider relations resource, will provide greater visibility into the status of edit resolutions both for providers and for SCDHHS. Providers can create a service ticket with the PSC through a web formor by phone at (888) 289-0709.

Providers should consider some key reminders regarding edits that occur as a result of incorrect enrollment information with Healthy Connections Medicaid and BabyNet. These reminders will help prevent some routine edits that are commonly identified as delaying claims resolution.

  • Providers must submit applications to enroll with both Healthy Connections Medicaid and BabyNet. It is imperative that provider information, such as National Provider Identifier numbers (NPI), taxonomies, names, addresses, etc. are consistent in both BRIDGES and MMIS. Inconsistency in enrollment information will result in a 941 and/or 946 edit.

  • Since some staff, including therapy assistants, are not permitted to enroll individually with Medicaid; they must enroll under their supervisor’s NPI with BabyNet. Failure to follow this process will result in a 941 and/or 946 edit.

  • When enrolling with Medicaid, providers should ensure their name and taxpayer identification number (either Federal Employer Identification Number [FEIN] or Social Security Number [SSN]) are consistent with what is on file with the Internal Revenue Service (IRS). A mismatch with a FEIN or SSN and a provider name will result in a 901 edit. More information about the 901 edit can be found here.

SCDHHS will contact providers directly in instances where further information is needed to successfully resolve a claim. Providers should not contact the BabyNet state office directly regarding claims edits issues as that information is provided to BabyNet by the PSC and duplicate contacts may lead to a delay in processing time. Providers can review the presentation on the Billing Companion Guide for BRIDGESon how to enter claim information correctly to reduce the number of edits they encounter. BabyNet staff is committed to resolving these claims as quickly as possible.

Additionally, SCDHHS understands providers may have received three specific edit codes including 976 - HOSPICE RECIPIENT/ SERVICE REQUIRES PA, 965 - PCCM RECIP/PROV NOT PCP-PROC REQ REFERAL and 994 - RECIP ELIG FOR EMERGENCY SVCS ONLY. These edit codes have been identified as requiring further analysis and may require policy revisions by SCDHHS. SCDHHS appreciates continued patience from providers while the analysis for these three specific edit codes is underway.

Updated Forms Available on BabyNet Website
Revised forms have been uploaded to the BabyNet website. Providers should visit the BabyNet forms sitefor instructions on completing the forms, examples of completed forms and to ensure they are utilizing the latest version of each document.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid and BabyNet programs.

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