Provider Revalidation: Group 4


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:

Provider Revalidation: Group 4

Other Medical Professionals

*Individual Physician

The following provider types located within Abbeville, Anderson, Cherokee, Chester, Fairfield, Greenville, Greenwood, Laurens, McCormick, Newberry, Oconee, Pickens, Saluda, Spartanburg, Union and York counties are also in Group 4 and require a site visit.


Community Long Term Care


Mental Health & Rehabilitation

Other Medical Professionals (Physical Therapists)

Contractual Transportation (Community Alternative Program Providers)

Independent X-Ray

*This will consist of the next 258 physicians whose Medicaid Legacy number begins with 0747-0842 and some
  whose legacy number begins with Q012.


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.

The revalidation process for Group 4 begins Sept. 21, 2015, and ends Oct. 20, 2015. The fourth group to begin the revalidation process is as follows:

For more information on the revalidation process, please visit or contact 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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