All Providers

Bulletins and Information for All Medicaid Providers

HCBS Statewide Transition Compliance

In accordance with the home and community-based services (HCBS) final rule regulations outlined in 42 CFR 441.301(c)(4)(i), the South Carolina HCBS Statewide Transition Plan will be submitted for final approval by the Centers for Medicare and Medicaid Services (CMS) no later than spring of 2019.

Third Party Liability (TPL)

Effective July 2, 2018, BlueCross BlueShield of South Carolina (BCBSSC) will perform the following third party liability (TPL) services on behalf of the South Carolina Department of Health and Human Services (SCDHHS):

 

Beneficiary Eligibility Impacts for June 2018

The Code of Federal Regulations (42 CFR 435.916) requires the state Medicaid agency to implement streamlined annual renewal processes for Medicaid beneficiaries under new modified adjusted gross income (MAGI) rules. These changes, designed to decrease the amount of paperwork received by beneficiaries and increase the use of automation, were first implemented in South Carolina in 2014. As with the traditional annual renewal process, individual beneficiaries that do not return the evidence necessary to maintain Medicaid eligibility exit the program after due notice. 

Changes to BabyNet Services Claims Payment Process

For payment dates effective July 1, 2018, the South Carolina Department of Health and Human Services (SCDHHS) will transition claims payment for BabyNet services from Jasper County Disabilities and Specials Needs (DSN) Board to SCDHHS. Providers must be registered in the South Carolina Enterprise Information System (SCEIS) before July 1, 2018, to avoid payment delays during this transition.

Rate Increase for Applied Behavior Analysis (ABA)

Effective on or after July 1, 2018, the South Carolina Department of Health and Human Services (SCDHHS) will increase reimbursement for Applied Behavior Analysis (ABA) provided by a Registered Behavior Technician (RBT) to $15.50 per 30 minutes ($31 per hour).

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 a series of provider training sessions throughout the state in May and September.

New Medicare ID Cards

Starting in April 2018, the Centers for Medicare and Medicaid Services (CMS) will issue new Medicare identification (ID) cards. 

The new cards will replace the Social Security Number-based Health Insurance Claim Number (HICN) currently on the card with a unique Medicare Beneficiary Identifier (MBI) to protect people with Medicare from identity theft. 

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

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