All Providers

Bulletins and Information for All Medicaid Providers

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.

End of Year Provider Payment Holiday Schedule

The South Carolina Department of Health and Human Services (SCDHHS) announces the following changes to the Healthy Connections Medicaid claims submission and payment schedule for December 2018 and January 2019 to accommodate holiday schedules.

Due to the Christmas holiday, Thursday, Dec. 20, at 5 p.m. is the final day to submit claims for payment date Friday, Dec. 28. Electronic remittance advices will be available Saturday, Dec. 22.

Please note, Thursday, Dec. 20, at 5 p.m. will be the final day to submit claims for a payment date within the calendar year 2018.

Pharmacy Providers and Other Medical Professionals

The South Carolina Department of Health and Human Services (SCDHHS) Pharmacy and Therapeutics (P&T) Committee meeting scheduled for Wednesday, Dec. 5, 2018, is canceled. 

An updated schedule of meeting dates for 2019 will be posted at a later date. 

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

For your convenience the Healthy Connections Member Contact Center is open Saturdays from 9 a.m.-noon, in addition to Monday-Friday, 8 a.m.-6 p.m. Call (888) 549-0820

November 2018 Provider Payment Holiday Schedule

The South Carolina Department of Health and Human Services (SCDHHS) announces the following changes to the Healthy Connections Medicaid claims submission and payment schedule for one week in November in order to accommodate the 2018 holiday schedule.

Due to the Thanksgiving holiday, Saturday, Nov. 17, at 5 p.m. is the final day to submit claims for payment date Friday, Nov. 23. Payments will run Monday, Nov. 19, and electronic remittance advices will be available Tuesday, Nov. 20. Payments will be dated Friday, Nov. 23, as usual.

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