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ATTENTION: Medicaid annual eligibility reviews were paused during the COVID-19 Public Health Emergency, but restarted April 1, 2023. 

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Provider Enrollment and Screening Requirements

The enrollment process includes screening, licensure verification and site visits (if applicable), to ensure that all enrolling providers are in good standing and meet the requirements for which they are seeking enrollment.

  • 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. 
  • If eligible, obtain a National Provider Identifier (NPI) and share it with South Carolina Medicaid. 
  • Be enrolled in the South Carolina Medicaid program and receive official notification of enrollment.

Once the provider has been approved for Medicaid enrollment, official notification of enrollment will be sent to the provider.

Online Enrollment

You can enroll using the online application. This process will ensure the security of providers' information and is accessible from any computer that has internet access. The web-based application will enable:

  1. New enrollment for individuals and organizations.
  2. Ordering/referring provider enrollment.
  3. Add a new location(s) to an existing enrollment
  4. Revalidation for individuals and organizations

Online Enrollment

Once you have completed minimal required information, you will receive a Reference ID#. Use this Reference ID# to retrieve and complete an in-process application. The in-process application must be submitted within 30 days. After 30 days, the in-process application will be purged and you must start the enrollment process over and be assigned another Reference ID#.

Complete an online provider enrollment application and agreement and submit any necessary supporting documentation to Provider Enrollment via fax at 803-870-9022. Indicate Reference ID# on all supporting documentation and/or communication in reference to the submitted application. Certain provider types, depending on the type of service provided, will be notified if the provider is required to sign a contractual agreement in addition to the provider enrollment agreement.

Accept the terms and conditions of the online application by electronic signature, indicating the provider’s agreement to the contents of the participation agreement, the Electronic Funds Transfer Agreement, W-9 and Trading Partner Agreement.

Application Fee and Payment

SCDHHS will collect the 2023 application fee of $688 prior to executing a provider agreement whether upon an initial enrollment, reactivation, revalidation, or an enrollment to add a new practice location. [Note: $631 for 2022] The provider enrollment application fee is applicable to providers that the Centers for Medicare & Medicaid Services (CMS) has identified as institutional providers. 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.

A provider will be exempt from the fee if they have submitted and received approval for a Hardship Waiver request or they can demonstrate they are enrolled or have paid the application fee to Medicare and/or another state’s Medicaid or CHIP for the same enrollment location jurisdiction. A different enrollment jurisdiction means “a new enrollment with an address different from a currently enrolled location.”

Individual physicians (sole proprietors enrolling with an EIN and Social Security Number (SSN) are considered individuals), non-physician practitioners and non-physician practitioner organizations are exempted from paying the enrollment application fee.

SCDHHS has contracted with SC.Gov Enterprise Payment System to facilitate collection of the application fee. Payments may be made online by electronic check, credit card or by debit from your checking or savings account. Visa, MasterCard, American Express and Discover are acceptable. Paper checks will not be accepted.

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Troubleshooting

When accessing the web application, if either of the two following situations occurs, you will need to make adjustments to your internet browser environment.

  • You correctly enter your NPI and you receive a display message that the NPI is not valid. The first time you may encounter this situation is when you are entering your Individual or Organization information. If you do not encounter this situation until later in the application, please verify that the NPI has been entered correctly.
  • Your view of the page shows an excessive amount of spacing between entry fields requiring an unusual amount of page scrolling. If you encounter this situation, it will occur after you select "Begin a New Enrollment". The next page displayed will require you to select either "New Enrollment" or "Add a Location". When you select either button, the “Enroll Now” button in the bottom right-hand corner should not disappear from your immediate page view. If the "Enroll Now" button is not viewable without scrolling, you will need to complete the steps listed below to solve the problem.

The issue causing either of these situations is the "compatibility view" settings of your internet browser. Completing the following steps will allow you to use the Provider Enrollment web application in the manner intended.

  1. Close your current web application by selecting "Exit Enrollment" in the upper right-hand corner of the application.
  2. Select “OK” to the pop-up message advising you that you will be exiting the application and any entered data will be lost.
  3. In the Menu bar of your internet browser, select "Tools".
  4. Selecting “Tools” will display a drop-down list of your browser settings.
  5. In the drop-down list, select the "Compatibility View Settings" entry.
  6. Confirm that "scdhhs.gov" does not appear in the text box labeled "Websites you’ve added to Compatibility View".
  7. Should the entry appear in the text box, click on the "scdhhs.gov" entry.
  8. Click the "Remove" button.
  9. Confirm that "scdhhs.gov" is removed from the text box.
  10. Select "Close" to close the window.
  11. You are now ready to once again begin your new enrollment application.

Web Application System Requirements

The interactive web application works with the following:

  • Internet Explorer: Version 8, Version 9
  • Firefox: Version 13, Version 14, Version 15, Version 16
  • Chrome: Version 23.0.1271.64
  • Safari: Version 6.0.1