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Bulletins and Information for All Medicaid Providers

Convenient Care Clinics Provider Enrollment and Place of Service Code 17


Effective with dates of service on or after August 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) provider enrollment policy will now allow Convenient Care Clinics (CCC) to enroll as a provider group for billing purposes. CCC’s are located in retail stores, supermarkets and pharmacies and are able to treat uncomplicated minor illnesses and provide preventative healthcare services.  They are often referred to as retail clinics, retail-based clinics or walk-in medical clinics.


New Services Performed by KePRO, the Quality Improvement Organization (QIO) for S.C. Medicaid


Effective August 1, 2012 the following will be added to the list of services that require prior authorization (PA) from KePRO.   


Durable Medical Equipment (DME)


Four Regional Provider/Stakeholder Meetings To Explore Options For Optional State Supplementation (OSS) Program

The South Carolina Department of Health and Human Services (SCDHHS), South Carolina Department of Mental Health (SCDMH), and the Adult Protection Coordinating Council will sponsor four regional stakeholder meetings focusing on issues related to Community Residential Care Facilities (CRCFs). These meetings will explore topics related to program enhancements for OSS, SCDMH funded services for consumers in CRCFs, and future initiatives improving quality of care in these facilities. The purpose of the sessions is to solicit input and program recommendations.

Hospice Care for Children in Medicaid


Effective immediately, the South Carolina Department of Health and Human Services will provide reimbursement for hospice services for children under 21 years of age in conjunction with curative treatment of the child’s terminal illness.


Section 2302 of the Affordable Care Act, entitled “Concurrent Care for Children” removes the prohibition of receiving curative treatment upon the election of the hospice benefit by or on behalf of children enrolled in Medicaid or Children’s Health Insurance Program (CHIP).  


Birth Outcomes Initiative Modifiers


In July 2011, the South Carolina Department of Health and Human Services (SCDHHS) began partnering with the South Carolina Hospital Association (SCHA), the March of Dimes, other state agencies, public and private providers and payors, consumers and advocacy groups in an effort to reduce the number of low birth weight babies born in South Carolina.  One of the first steps towards this goal was the elimination of non-medically necessary elective inductions and elective cesareans prior to 39 weeks gestation.


Services Performed by KePRO, the Quality Improvement Organization (QIO) for S.C. Medicaid

This bulletin is to notify you that the July 1, 2012 effective date to automatically reject claims that require an authorization number from KePRO, if the authorization number is not present on the claim or is invalid, has been delayed until August 1, 2012.  The delay is due to required detailed testing of the claims processing system which is necessary to minimize the potential for rejecting claims in error.  This policy affects Medicaid Fee-For-Service members including members enrolled in Medical Home Networks (MHNs).

Continuation of the IPC Program


By a letter dated June 6, 2012, you were advised of the ongoing dialogue between the South Carolina Department of Health and Human Services (SCDHHS) and the Centers for Medicare & Medicaid Services (CMS) concerning our Integrated Personal Care (IPC) Service.  The letter stated that the IPC program would no longer accept new referrals, effective June 15, 2012.  SCDHHS is hereby rescinding the June 6, 2012 letter.


Update to Screening Brief Intervention and Referral to Treatment (SBIRT) Initiative

The South Carolina Department of Health and Human Services (SCDHHS) began the Screening, Brief Intervention and Referral to Treatment (SBIRT) initiative in August 2011. In the Department’s effort to improve birth outcomes and overall health of the Mom and Baby, we have partnered with other stakeholders throughout the state to help identify and treat pregnant beneficiaries who may experience alcohol or other substance dependencies, depression, smoking, or domestic violence.

Absolute Total Care-Corrective Action Plan to Address Non-compliance

This CAP is necessary in order for ATC to address their non-compliance for failure to pay claims in a timely manner.  ATC has a large number of unpaid, denied and disputed claims outstanding with providers including major hospitals, physician groups, ambulance providers and others.  ATC has contracted with SCDHHS since 2007 and serves approximately 87,700 South Carolina Medicaid enrollees in 39 counties.

SCDHHS Offers Free Provider Workshops June-August 2012

Attached is a schedule of the free provider workshops offered by the
SCDHHS to include Medicaid Basics, Comprehensive Web Tool, Overview of
Third Party Liability and Overview of Claim-level Adjustments.


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