Provider Revalidation: Group 3


In the bulletin dated April 20, 2015, providers were informed their enrollment information must be revalidated, per the Centers for Medicare and Medicaid Service (CMS). To avoid risk of termination in the South Carolina Department of Health Human Services (SCDHHS) Healthy Connections Medicaid program, you must complete and submit an enrollment application 30 days from the date of your official revalidation notification letter. DO NOT begin the revalidation process until you receive notification. The notification contains pertinent information needed to start and complete the revalidation process.

In addition, the enrollment application fee is ONLY applicable to providers that CMS has identified as institutional providers. The application fee must be collected before a revalidation provider enrollment agreement is received, unless the provider is already enrolled in Medicare, enrolled in another state’s Medicaid or CHIP program or submitted and received approval for a Hardship Waiver request. 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 State Renal Disease Facilities; Federally Qualified Health Centers; Home Health Agencies; Hospices; Hospitals, Acute Inpatient Facilities, Inpatient Psychiatric Facilities, Inpatient Rehabilitation Facilities, Independent Clinical Laboratories; Skilled Nursing Facilities and Rural Health Clinics.

Provider Revalidation:  Group 3
Individual Dentist Individual Optometrist *Individual Physician
Home Health Hospice  

The following provider types located within Berkeley, Chesterfield, Clarendon, Darlington, Dillon, Florence, Georgia within Medicaid Service Area, Georgia outside Medicaid Service Area, Georgetown, Horry, Kershaw, Lancaster, Lee, Marion, Marlboro, NC within Medicaid Service Area, NC outside Medicaid Service Area, Out of State, Sumter and Williamsburg counties are also in Group 3 and require a site visit.

Ambulance Community Long Term Care Laboratory
Mental Health & Rehabilitation Other Medical Professionals (Physical Therapists) Contractual Transportation (Community Alternative Program Providers)
Independent X-Ray    

*This will consist of the next 5,718 physicians whose Medicaid Legacy number begins with 0012–TL99.

The revalidation process for Group 3 begins Aug. 11, 2015, and ends Sept. 9, 2015. The third group to begin the revalidation process is as follows:

For more information on the revalidation process, please visit the Provider Service Center at (888) 289-0709, option 4.

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

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