All Providers

Bulletins and Information for All Medicaid Providers

New Medicaid Provider Manuals Provider Training

The South Carolina Department of Health and Human Services (SCDHHS) has worked with stakeholders, for the past year, to update and streamline Medicaid provider manuals.

Before transitioning to the platform and format for provider manuals, or guides, the agency will hold a series of provider trainings. These trainings will occur in three locations (Charleston, Columbia, Greenville) in June to provide an overview of the basic structure of the guides, the new approach to coding and rate information and an introduction of the new Provider Administrative and Billing Guide.

Hepatitis A Outbreak

On Monday, the South Carolina Department of Health and Environmental Control (DHEC) announced that cases of hepatitis A across the state have reached outbreak level. Hepatitis A is a contagious liver infection that is transmitted through person-to-person contact with someone who has the infection or through eating or drinking food or water contaminated by an infected person.

Healthy Connections Choices Enrollment Broker Training

The South Carolina Department of Health and Human Services (SCDHHS), in partnership with the state’s contracted enrollment broker, MAXIMUS, will facilitate two provider training sessions in May. 

Autism Spectrum Disorder State Plan Procedure Codes

Effective May 1, 2019, the South Carolina Department of Health and Human Services (SCDHHS) will transition from the 2014 Category III Current Procedural Terminology (CPT) codes for adaptive behavior services to the 2019 Category I CPT codes. The 2019 Category I CPT codes are: 

• 97151 – Behavior identification assessment, each 15 minutes

• 97153 – Adaptive behavior treatment by protocol, each 15 minutes

• 97155 – Adaptive behavior treatment with protocol modification, each 15 minutes

• 97156 – Family adaptive behavior treatment guidance, each 15 minutes

HEDIS® Tips

Medicaid managed care organizations (MCOs), who contract with the South Carolina Department of Health and Human Services (SCDHHS) for the provision of Medicaid services, request medical records from providers to comply with SCDHHS's requirements for reporting Healthcare Effectiveness Data and Information Set (HEDIS®). Thank you for cooperating with the MCOs' medical record requests and ensuring that any medical record vendors do so as well.

SCDHHS and KEPRO Provider Quality Improvement Training

The South Carolina Department of Health and Human Services (SCDHHS) will co-sponsor provider and facility training with Keystone Peer Review Organization (KEPRO), the SCDHHS quality improvement organization. The annual quality improvement training includes requirements, updates and a review of the process and procedures for prior authorization.

The online training sessions will be held May 14 and 16, at 10 a.m. and 1 p.m. Registration is not required.

KEPRO online training dates:

  • May 14, 10 a.m. and 1 p.m.
  • May 16, 10 a.m. and 1 p.m.

 

Provider Enrollment Procedures for Early Intervention Providers

Beginning April 1, 2019, the South Carolina Department of Health and Human Services (SCDHHS) will directly enroll certain early intervention providers in the Medicaid provider network. Providers subject to this direct enrollment alert are those qualified by the South Carolina Department of Disabilities and Special Needs (SCDDSN) and provide services to children aged 0-3 who are -enrolled in South Carolina’s Individuals with Disabilities Education Act (IDEA), Part C program, called BabyNet.  

Changes to Program Integrity Prepayment Claims Review Policy

Effective April 1, 2019, the South Carolina Department of Health and Human Services (SCDHHS) will amend the Prepayment Claims Review Policy to allow the submission of electronic claims. Unless otherwise specified, claims subject to program integrity prepayment claims review may be submitted electronically. This includes both the claims and the supporting documentation. Providers should carefully review the current manual for compliance with policy guidelines.

HEDIS® and HEDIS Record Requests

South Carolina Medicaid managed care organizations (MCOs) request medical records from providers to comply with the requirements the South Carolina Department of Health and Human Services (SCDHHS) has for reporting Healthcare Effectiveness Data and Information Set (HEDIS®). Please cooperate with the MCOs' medical record requests and ensure that any medical record vendors do so as well, and/or provide the means through which an MCO may access medical records of Medicaid members. Generally, access to medical records is included in network contracts.

2019 Provider Enrollment Application Fee

The Centers for Medicare and Medicaid Services (CMS) has announced the enrollment application fee amount for calendar year 2019 will be $586. This fee is required with any applicable Healthy Connections Medicaid provider enrollment application submitted on or after Jan. 1, 2019, and on or before Dec. 31, 2019.

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