Institutional Provider Clarification

PROVIDER ALERT

The Centers for Medicare and Medicaid Services (CMS) has provided further clarification on those identified as institutional providers. Based on this clarification, the institutional providers listed in Medicaid Alert regarding the 2016 Provider Enrollment Application Fee dated Dec. 14, 2015, has been amended. South Carolina Healthy Connections Medicaid recognizes and enrolls the following institutional providers:

Ambulatory Surgery Centers, Community Mental Health Centers, Comprehensive Outpatient Rehabilitation Facilities, Durable Medical Equipment, End Stage Renal Disease Facilities, Federally Qualified Health Centers, Home Health Agencies, Hospices, Hospitals, Independent Clinical Laboratories, Pharmacies, Skilled Nursing Facilities and Rural Health Clinics.

The South Carolina Department of Health and Human Services (SCDHHS) will collect the 2016 provider enrollment application fee of $554.00 before executing a provider agreement for any institutional provider enrollment application received on or after Aug. 1, 2016. The application fee is applicable for an initial enrollment, reactivation, revalidation or addition of 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. Please refer to https://www.scdhhs.gov/provider and select, "Online Application Fee Payment" under Provider Quick Links to pay enrollment application fee.

The application fee requirement exceptions are:

  1. Individual physicians (sole proprietors enrolling with a Social Security Number (SSN) and Employer Identification Number (EIN) are considered individuals) and non-physician practitioners and non-physician practitioner organizations.
  2. Providers who are enrolled in or have already paid the application fee to Medicare and/or another state's Medicaid agency or Children's Health Insurance Program (CHIP) for the same enrollment location jurisdiction.
  3. Providers who have submitted and received approval for a Hardship Waiver request.

 

SCDHHS's goal is to continue to enhance the integrity of the Healthy Connections Medicaid program while complying with federal requirements. If you have any questions regarding provider enrollment and screening, please contact the Provider Service Center at (888) 289-0709, option 4 or visit https://www.scdhhs.gov/provider for additional information.

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

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