All Providers

Bulletins and Information for All Medicaid Providers

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.

New Provider Enrollment and Screening Requirements

 

The South Carolina Department of Health and Human Services (SCDHHS) will be implementing new provider enrollment and screening regulations published by the Centers for Medicare and Medicaid Services (CMS).  These regulations have been developed under standards established by the Affordable Care Act.  Prior to implementation, new policies for provider enrollment and screening will be communicated to providers in subsequent Medicaid bulletins.  Provider enrollment and screening information and a link to the new Federal regulations, can be found on the SCDHHS website at:

 

SCDHHS Offers Free Provider Workshops May - July 2012

To attend these training sessions, you may register through the South
Carolina Medicaid Provider Outreach Web site
at www.scmedicaidprovider.org or by calling the South Carolina Medicaid
Provider Service Center at 1-888-289-0709. Select menu option 1 for the
Electronic Data Interchange (EDI) Support Center.

~~~TRAINING SESSIONS ARE NOW AVAILABLE ONLINE ~~~

To access the online training sessions through our e-learning Web site:

Quality Improvement Organization (QIO) Training Session

 

 

The South Carolina Department of Health and Human Services (SCDHHS) will co-sponsor provider/facility training with Keystone Peer Review Organization, Inc. (KePRO), the new QIO for Medicaid.  KePRO will offer 4 regional trainings with morning sessions designated for facility staff.  Afternoon sessions are designated for physicians and other medical professionals. 

New Medicaid Quality Improvement Organization (QIO)

 

Effective March 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) began implementation of a contract with the Keystone Peer Review Organization, Inc. (KePRO), to serve as the new Quality Improvement Organization with an operational date of June 1, 2012.

 

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