This page information and details on the South Carolina Department of Health and Human Services (SCDHHS) provider enrollment revalidation process.
WHAT'S NEW
Flexibilities offered by the Centers for Medicare and Medicaid Services (CMS) to all state Medicaid agencies during the federal COVID-19 public health emergency (PHE), allowed for the temporary suspension of the Medicaid provider enrollment revalidation process. With the conclusion of the federal PHE in 2023, the South Carolina Department of Health and Human Services (SCDHHS) is required to resume the provider revalidation process. SCDHHS will restart this process in June 2024.
USEFUL TIP
A list of providers in the current provider enrollment revalidation group is available for download. Providers may check this to see if they are in the current group by clicking Provider Groups below. Organizations and systems comprising multiple providers may download the applicable file below, which includes NPI numbers, to compare the file with their provider list file. If an organization determines their providers are up for revalidation in the current provider group, they may request revalidation information for each provider by submitting a Contact a Provider Representative inquiry or calling the Provider Service Center at (888) 289-0709, option 4.
- Provider Groups
SCDHHS will notify providers when to begin the revalidation process and the specific date by which the provider's enrollment must be revalidated. Providers are divided into groups for the provider enrollment revalidation. Providers should not take any steps to revalidate their enrollment until they receive an official notification letter from SCDHHS.
Provider Revalidation Cohorts:
- Background
The Centers for Medicare & Medicaid Services (CMS) has mandated that providers revalidate their enrollment information. Providers should not take any steps to revalidate their enrollment until they receive an official notification letter from SCDHHS.
- Resources
Communications
- Medicaid Bulletin: Restart of Provider Revalidation
- Example: Provider Enrollment Revalidation Letter
- FAQs
Are all providers required to go through the revalidation process?
Yes. The Centers for Medicare and Medicaid Services (CMS) requires all providers to revalidate based on their designated risk level. Limited and moderate risk providers revalidate every five years and high-risk providers revalidate every three years.
What do I need to do to prepare for revalidation?
It is highly recommended that you make sure your national provider identifier (NPI), legacy number, tax ID, mailing address, service location address and name are current with the South Carolina Department of Health and Human Services (SCDHHS). Refer to your respective provider manual for instructions on how to complete the update process.
How do I make sure that my address and other information is correct?
To verify your current address, you may check the Search for Providers directory here. To confirm other information, contact the Provider Service Center (PSC) at (888) 289-0709, select option 4. Note: The PSC representative cannot change your address if you identify a discrepancy. You must submit a signed letter requesting the address change on business letterhead with an authorized printed name and signature.
Will all providers revalidate at the same time?
No. You will receive a letter from SCDHHS when it is your turn to revalidate. Please do not attempt to begin the revalidation process until you have received direct instruction from SCDHHS.
How will I be notified?
South Carolina Healthy Connections Medicaid will notify providers via a letter. This letter will include a unique revalidation number. You will use this information to access the online provider revalidation enrollment application and also to follow-up on the status of your revalidation through the PSC at (888) 289-0709, option 4.
When is revalidation due?
Because provider types have differing risk levels and associated requirements, this deadline varies. Typically, providers have 30 days from the date of their notification to complete and submit their application. However, providers should refer to the individual revalidation notification they receive to determine their specific deadline.
Approximately how long does it take to complete and submit a provider revalidation application?
The amount of time to complete and submit the online portion of a provider revalidation application should take approximately 30 minutes. Being prepared with all required application information (i.e., NPI, tax and ownership information) will help expedite the completion and submission of the application. Providers who are designated as high-risk have additional requirements. These include fingerprint submission and/or a physical site visit. This part of the process may take longer than the 30-day deadline. If you are a high-risk provider, as long as you submit a copy of your fingerprinting appointment confirmation along with other requested documents, you will not be terminated.
What if I do not submit my provider revalidation by the deadline?
Providers who do not complete and submit the provider revalidation application within the timeframe will be considered as having voluntarily terminated from the Healthy Connections Medicaid program. Providers will no longer receive payments and will need to reapply as a Healthy Connections Medicaid provider.
Where should I expect my revalidation notification letter to be mailed?
Your revalidation notification letter will be mailed to the primary practice location SCDHHS has on file. Contact the PSC at (888) 289-0709, select option 4, and ask for confirmation of the primary practice location and payment address associated with each of your Medicaid legacy numbers. Note: The PSC representative cannot change your address if you identify a discrepancy. You must submit a signed letter requesting the address change on business letterhead with an authorized printed name and signature.
I have not received my revalidation notification letter, is there another way that I can get my revalidation number?
Contact the PSC at (888) 289-0709, option 4, to request a duplicate revalidation notification letter. Note: The PSC cannot provide your unique revalidation number via phone.
What if I change my Electronic Funds Transfer (EFT) Authorization Agreement during revalidation?
Please be advised that any change to your financial information is subject to a 15-day precertification period in which all accounts are verified by the qualifying financial institution before direct deposits are made to your account. During the precertification period, the provider will receive reimbursement via a hard copy check. The hard copy check will be mailed to the payment address currently on file. Refer to the EFT section of the Provider Administrative and Billing Manual for additional EFT information or contact the PSC at (888) 289-0709 and selection option 4.
For More Information
If you have additional questions regarding provider revalidation, please contact the PSC at (888) 289-0709, select option 4, and reference the issue code REVAL.