All Providers

Bulletins and Information for All Medicaid Providers

SCDHHS and KEPRO to Hold Provider Quality Improvement Training

The South Carolina Department of Health and Human Services (SCDHHS) will co-sponsor provider and facility training with the 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.

Deemed Baby Process

The South Carolina Department of Health and Human Services (SCDHHS) implemented a new eligibility system in November. Throughout the launch, SCDHHS worked diligently to ensure the Agency provided timely and accurate eligibility determinations.  

During the system changeover, there was a delay in the completion of final determinations. SCDHHS continues to process applications and aims to be completely in the new system, resuming standard eligibility determination turnaround times, in the next few weeks. 

Co-payments

The South Carolina Department of Health and Human Services (SCDHHS) has amended the Schedule of Co-payments found in the appendix section of all manuals. The schedule now includes all Current Procedural Terminology (CPT) and Healthcare Current Procedural Coding System (HCPCS) codes that a provider has the option to charge and collect co-payments from a Healthy Connections member. The chart can be found in the appendix section of all manuals.

ACA Enhanced Physician Payment Reimbursement Discontinued. Primary Care Fee Schedule Enhancement

ACA Enhanced Physician Payment Reimbursement Discontinued December 31, 2014

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented a portion of the final rule under the Affordable Care Act (ACA) that increased Medicaid reimbursements for evaluation, management and immunization procedure codes for two years. The increase applied to both fee-for-service (FFS) and Medicaid Managed Care Organizations (MCOs).

Intensive Family Services Contact

For questions or comments regarding the bulletin, Intensive Family Services (Procedure Code H0046), posted November 17, please contact the Provider Service Center at (888) 289-0709.

Claim Reconsideration Policy-Fee For Service (FFS) Medicaid

Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Claim Reconsideration Policy directives will be located in all Provider Manuals in Section 3, Billing Procedures. When requesting a reconsideration, providers must adhere to all applicable policies, timely filing limits, and must comply with the following procedures:

Policy Revisions to the Local Education Agency (LEA) Services Manual for Rehabilitative Behavioral Health Services (RBHS)

The South Carolina Department of Health and Human Services (SCDHHS), Division of Behavioral Health, will revise the Local Education Agency (LEA) manual for the Rehabilitative Behavioral Health Services (RBHS) policy section to discontinue use of the FORM 255 as of November 1, 2014. The Department of Education will continue to ensure the LEAs track the referral process for Psychological Testing and Evaluation.

Update to Section 1 of All Provider Manuals

The South Carolina Department of Health and Human Services (SCDHHS) currently contracts with six (6) Managed Care Organizations (MCOs). Each MCO currently operating in South Carolina has a small percentage of contracted network providers that have not enrolled directly with SCDHHS. The most recent contract between SCDHHS and each MCO requires that their contracted provider network also be enrolled directly with SCDHHS. This requirement was implemented to provide for accuracy in MCO reporting and to assist SCDHHS in monitoring and ensuring ongoing provider compliance.

Modified Claim Submission and Payment Schedule for November and December 2014

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 two weeks in November and one week in December.

New Tuberculosis Benefit

Effective for dates of service on or after November 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will implement a new program that offers Healthy Connections Medicaid coverage to persons with latent tuberculosis (TB) or active TB infection/disease who are uninsured or underinsured and who do not meet the eligibility criteria for full Healthy Connections Medicaid. This program will be administered through the South Carolina Department of Health and Environmental Control (SCDHEC).

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