Provider Information

Provider Manuals

Most Recently Updated Manuals.
Go to Provider Manual List for the full list of all provider manuals.

Fee Schedules

Physicians

Enhanced Qualifying Primary Care

Family Practice, General Practice, Osteopath, Internal Medicine, Pediatrics, Geriatrics

Effective For Dates Of Service 01/01/16

Excluded Providers List

Credit Balance Forms

Provider Enrollment and Screening Requirements

  • Be licensed by the appropriate licensing body, certified by the standard-setting agency, and/or other pre-contractual approval processes established by South Carolina Department of Health and Human Services (SCDHHS).
  • Continuously meet South Carolina licensure and/or certification requirements of their respective professions or boards in order to maintain Medicaid enrollment.
  • Comply with all federal and state laws and regulations currently in effect as well as all policies, procedures, and standards required by the Medicaid program.

Resources

Fee Schedules

Physicians Enhanced Qualifying Primary Care 2015_EN_QUAL_PRI_CARE_SCHED.xlsx 2015_EN_QUAL_PRI_CARE_SCHED.pdf Family Practice, General Practice,...

RBHS Carve-In

Effective July 1, 2016, the SCDHHS will include outpatient mental health services and Rehabilitative Behavioral Health Services (RBHS) as part of the...

Palmetto Coordinated System of Care

The Palmetto Coordinated System of Care is a program to help children stay: at home in school when possible, out of the child welfare system, and...

Carrier Codes

  Megallan Carrier Code List Alpha4/1/2016 (MS Excel Spread sheet) Megallan Carrier Code List Numeric4/1/2016 (MS Excel Spread sheet) Carrier Code...

Electronic Data Interchange (EDI)

  Electronic claims are processed faster and more accurately than those received by mail. SCDHHS will provide an electronic response indicating that...

SC Medicaid Companion Guides

South Carolina Medicaid Companion Guides supplement the HIPAA-required ANSI X-12 Implementation Guide to explain billing instructions specific to...

Provider Enrollment and Screening Requirements

Be licensed by the appropriate licensing body, certified by the standard-setting agency, and/or other pre-contractual approval processes established...

File Appeals & Reschedule/Cancel Hearings Online

You can now file your appeal online and make requests to reschedule or cancel hearings and withdraw appeal requests on the new Appeals and Hearings...

APR-DRG

The South Carolina Department of Health and Human Services (SCDHHS) intends to move to a new method of paying for hospital inpatient services. The...

ICD-10

Read More about the ICD-10 Implementation The South Carolina Department of Health and Human Services (SCDHHS) is moving forward in updating our...

HCBS Final Rule

The Home and Community-Based Services (HCBS) rule creates a more outcome-oriented definition of home and community-based settings. It does not just...

Healthy Connections Checkup

Medicaid has added to our Family Planning benefit and now offers screenings and a physical exam. We still cover birth control and now also cover:

New Tool! SC HealthViz

Access maps, reports and data on Medicaid health services in South Carolina SC HealthViz is designed to provide greater transparency of the data that...

Proviso 33.34

The 2014 budget currently includes Proviso 33.34 which-for the first time-provides funds that may only be accessed if hospitals and clinics serving...

Affordable Care Act Initiatives

South Carolina Department of Health and Human Services (SCDHHS) received final State Plan Amendment approval for the payment methodology for enhanced...

OSS Advisories

OSCAP advisory August 2013   July 1, 2013 OSCAP Advisory07/09/2013 February 2013 OSS AdvisoryDescription: OSS Advisory NewsletterPosted:01/29/2012...

Claim Submission Tool (Web Tool)

Web tool

Medicaid Web-based Claims Submission Tool Send CMS-1500 and UB-04 claims and their associated adjustments to SC Medicaid via the Internet. Support...

MHN/MCO Eligibility Verification Feature Now Available

  Effective Tuesday, June 12, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will add a new feature to the SC Web-based...

Organizations

Adult Protection Coordinating Council

The Adult Protection Coordinating Council was created by the South Carolina General Assembly to foster coordination and cooperation among multiple...

Money Follows the Person

Home Again is a program assisting seniors, individuals with disabilities, and children with severe emotional disturbances who currently live in...

South Carolina Birth Outcomes Initiative

South Carolina Birth Outcomes Initiative Success video Webinars Evidence-based Interventions to Prevent Spontaneous Preterm Birth Presentation...

Transportation Advisory Committee

The advisory committee shall meet at least quarterly to review issues and complaints concerning the Medicaid Transportation Brokerage System and...

Medical Care Advisory Committee

The Medical Care Advisory Committee (MCAC) of the South Carolina Department of Health & Human Services advises the Department of Health and Human...

Screening, Brief Intervention and Referral to Treatment (SBIRT)

What is SBIRT?  SBIRT is evidence based, integrated and comprehensive approach to the identification, intervention treatment/referral of substance (...

Home Health

Conditions and Criteria for Home Health Services: Home Health Services are intermittent skilled nursing services, physical therapy, speech therapy,...

Estate Recovery

In August of 1993, Congress passed a law that requires states to recover amounts that Medicaid has paid for certain recipients. In South Carolina the...

Division of Community and Facility Services

The Division of Community and Facility Services is responsible for oversight for the following Medicaid programs: home health, hospice,nurse aide...

Nurse Aide Registry, Testing and Training

The South Carolina Healthy Connections Medicaid is committed to ensuring that anyone who is interested in becoming a Certified Nursing Assistant (CNA...

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