All Providers

Bulletins and Information for All Medicaid Providers

Medicaid cards now have a new design

Medicaid cards have been updated to reflect the new Healthy Connections logo, as pictured at right.

Cards with the previous design (below) are still in use and valid too, so please accept either version from your Medicaid beneficiaries.

Discontinuation of Edit Correction Forms (ECFs)

The South Carolina Department of Health and Human Services is improving provider communications regarding the status of claims submitted to SC Medicaid.  Effective January 3, 2014, providers will no longer receive Edit Correction Forms (ECFs) for rejected claims.  Additionally, effective April 1, 2014, SC Medicaid will no longer accept provider corrected ECFs.  Providers will be required to submit a new claim form to resolve billing edits.

Transition to the CMS-1500 Health Insurance Claim Form (02-12) version

In response to guidelines recommended by the National Uniform Claim Committee (NUCC) and set forth by the Centers for Medicare and Medicaid Services (CMS), the South Carolina Department of Health and Human Services (SCDHHS) is implementing the revised CMS-1500 Health Insurance Claim Form (02-12) version effective January 6, 2014.

Although the CMS-1500 form (02-12) is effective January 6, 2014, use of the revised form is optional until March 31, 2014.  The transitional dual acceptability period of the current and the revised forms is described as follows:

Tetanus, Diphtheria and Pertussis (Tdap) Vaccine


Medical providers who “buy and bill” for the Tdap vaccine should use the Current Procedural Terminology (CPT) code 90715.  For administration of the vaccine, providers should bill CPT code 90471 or 90472, as appropriate. 

Tdap vaccines will also be covered through the pharmacy benefit for adult beneficiaries, so long as a prescription is provided for the vaccine.  Pharmacy providers should submit claims for the Tdap vaccine through the point-of-sale (POS) system. 

Managed Care Organizational Changes. Explanation of the Organizational Changes

  1. Managed Care Organizational Changes

Effective January 1, 2014, all current Medical Home Networks (MHN) Plans operating within the state will become Managed Care Organizations (MCO) either through acquisition or conversion.

Quality Improvement Organization (QIO) Training Session

The South Carolina Department of Health and Human Services (SCDHHS) will co-sponsor provider/facility training with the Medicaid QIO, Keystone Peer Review Organization, Inc., (KePRO).

Training Sessions will Include:

Enhanced Physician Payment Reimbursement


The South Carolina Department of Health and Human Services (SCDHHS) recently received final CMS approval for its proposed payment methodology for the Affordable Care Act (ACA) Primary Care Physician rate increase for both the Fee for Service (FFS) and Managed Care Organizations (MCOs).  SCDHHS continues its work on this project to ensure that it is implemented accurately, quickly and within the CMS mandates for these enhanced payments.  


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