All Providers

Bulletins and Information for All Medicaid Providers

2018 Provider Revalidation

The South Carolina Department of Health and Human Services (SCDHHS) is beginning 2018 provider revalidation. Providers who enrolled as a Healthy Connections Medicaid provider between Dec. 1, 2012-Dec. 31, 2013, are scheduled for revalidation in 2018. 

Medicaid Periodicity Schedule

To ensure the highest quality care to children enrolled in the South Carolina Medicaid program, the South Carolina Department of Health and Human Services (SCDHHS) adopts the following updates and reminders regarding Early and Periodic Screening, Diagnosis and Treatment (EPSDT) coverage policy. The EPSDT benefit is available to Medicaid beneficiaries under the age of 21.

Medical Periodicity Schedule

HEDIS® Tips

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®). Thank you for cooperating with the MCOs' medical record requests and ensuring that any medical record vendors do so as well.

Tips to Avoid Noncompliance and Boost HEDIS Rates

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.

Policy for Prescribing, Dispensing and Administering Controlled Substances

South Carolina Governor Henry McMaster issued Executive Order No. 2017-43, setting a five-day limit for certain opioid prescriptions and a supplemental requirement for the South Carolina Department of Health and Human Services (SCDHHS) to articulate opioid dosing guidelines in policy.

The five-day limit is for initial opioid prescriptions for acute and post-operative pain management. The policy will provide exceptions when clinically indicated. Additionally, SCDHHS will recommend best practices that require legislative or regulatory action to the Opioid Emergency Response Team.

2018 Provider Enrollment Application Fee

The Centers for Medicare and Medicaid Services (CMS) has announced the enrollment application fee amount for calendar year 2018 will be $569. This fee is required with any applicable Healthy Connections Medicaid provider enrollment application submitted on or after Jan. 1, 2018, and on or before Dec. 31, 2018.

Free Provider Workshops: December 2017 - February 2018

Below is a schedule of the free provider workshops offered by the South Carolina Department of Health and Human Services (SCDHHS), including Medicaid Basics, Comprehensive Web Tool and Claim-level Adjustments and Third-Party Liability.

To attend these training sessions, you may register through the Healthy Connections Medicaid Provider Education website, Medicaidelearning.com, or call the Provider Service Center at 1 (888) 289-0709 and select option 1 from the main menu.

 

Medicaid Basics 

Dec. 12, 10 a.m.-4 p.m., Columbia

November 2017 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 2017 holiday schedule.
 
Due to the Thanksgiving holiday, Saturday, Nov. 18, at 5 p.m. is the final day to submit claims for payment date Friday, Nov. 24. Payments will run Monday, Nov. 20, and electronic remittance advices will be available Tuesday, Nov. 21. Payments will be dated Friday, Nov. 24, as usual.
 

Children’s Private Duty Nursing Staffing Requirement Change

The South Carolina Department of Health and Human Services (SCDHHS) is revising its staffing requirements for the Children's Private Duty Nursing Program.

Effective Oct. 1, 2017, in lieu of having one year of pediatric nursing experience in a clinical setting, nursing providers may submit a pediatric nurse training program for registered nurses (RNs) and licensed practical nurses (LPNs) to SCDHHS for review and potential approval.

New Centralized Intake Call Center Phone Number

The South Carolina Department of Health and Human Service (SCDHHS) Community Long Term Care (CLTC) centralized intake call center telephone number will change to (888) 971-1637, effective Monday, July 31, 2017.

This call center is used to make referrals for long term care waiver services, Children's Personal Care Service, nursing home placement, nursing facility conversion, incontinence supplies, the Home Again program, Pre-admission Screening Resident Review (PASRR) and the Tax Equity and Fiscal Responsibility Act (TEFRA), also known as Katie Beckett children's Medicaid.

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