All Providers

Bulletins and Information for All Medicaid Providers

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.  

Application of the Mental Health Parity and Addiction Equity Act (MHPAEA)

 

 

The South Carolina Department of Health and Human Services (SCDHHS) is issuing this bulletin for guidance on the application of MHPAEA in Medicaid.

History and Background

Starting in 1996, Congress enacted several laws designed to improve access to mental health and substance use disorder services under health insurance or benefit plans that provide medical/surgical benefits.

Alert: For providers who have been impacted by the 775 edit.

For providers who have been impacted by the 775 edit (Early Delivery <39 weeks not medically necessary), we have identified an internal processing error causing properly billed claims to be rejected. This issue has been corrected and all previously submitted claims will be reviewed and reprocessed for payment date of May 3. There is no additional action necessary from providers. We apologize for any inconvenience this has caused and appreciate your participation in SC Medicaid.

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