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Hospital Discharge Planners

 

Effective immediately, Medicaid eligible hospital patients who no longer require acute care and are seeking long term care may exempt the waiting list for Community Choices. An assessment and level of care must be made by CLTC prior to the patient’s discharge. Referrals must be made to the appropriate CLTC office.

Medicaid Insurance Verification Services (MIVS) - Third Party Liability (TPL) Support Services

 

Effective November 1, 2011, the Medicaid Insurance Verification Services (MIVS) contract will no longer be administered by Affiliated Computer Services, Inc.  Blue Cross Blue Shield of South Carolina (BCBSSC) will be performing the following services on behalf of the South Carolina Department of Health and Human Services (SCDHHS):

 

SCDHHS Announces Use of National Correct Coding Initiative (NCCI) on a Prepayment Basis

 

NCCI Background and FAQs

Initially National Correct Coding Initiative (NCCI) was developed by CMS for Medicare Part B claims and is now being implemented for state Medicaid programs.

ATC Medicaid managed care plan scaling back in Upstate

COLUMBIA, SC—Approximately 8,100 South Carolina Medicaid beneficiaries in the Upstate who are enrolled in the Absolute Total Care (ATC) managed care plan will soon be asked to choose another plan, the South Carolina Department of Health and Human Services (SCDHHS) announced Wednesday. The announcement comes after ATC notified the Department it intends to withdraw from participation in Spartanburg, Cherokee and Union counties.

MEDICAID SCAM ALERT

Medicaid and Medicare scams are becoming more common throughout the country, and often
prey upon elderly and disabled residents for the purposes of identity theft or to fraudulently
purchase goods.

Durable Medical Equipment (DME) Providers

The South Carolina Department of Health and Human Services (SCDHHS) is changing the billing procedures for all oral nutritional supplement and incontinence providers. This change will streamline the billing process and allow you to receive referrals and authorizations from CLTC (Community Long Term Care) in an electronic format.

Final Notice Of Action

PUBLIC NOTICE
FINAL NOTICE of ACTION
SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Payment to Medicaid Providers Reduced and Beneficiary Co-payments Increased July 11, 2011
The South Carolina Department of Health and Human Services (SCDHHS), as required by
Federal Regulations of Title 42 Part 447 Section 205, gives final notice of the following actions
regarding its methods and standards for paying providers and beneficiary cost sharing under the
State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Medicaid Reimbursement Changes

The South Carolina Department of Health and Human Services (SCDHHS) announces the
following changes to maintain expenditures within budget appropriations for State Fiscal Year
2012. Public Notice of the proposed changes was published June 6, 2011. Comments were
accepted and considered through 5:00 p.m. July 6, 2011. The reductions in this notice are in
addition to the previous reduction of 3% that was applied on April 8, 2011.

Preferred Drug List (PDL) Revisions

I. Preferred Drug List (PDL) Revisions
II. Processing of Claims for Compounded Pharmaceuticals
III. Six Month's Supply for Contraceptives

Transportation Broker Contract Awards

On May 24, 2011, the South Carolina Department of Health and Human Services (SCDHHS) received final notice from the South Carolina Materials Management Office that two brokers were awarded Non-Emergency Medical Transportation (NEMT) contracts; LogistiCare Solutions, LLC and American Medical Response, Incorporated.

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