All Providers

Bulletins and Information for All Medicaid Providers

HEDIS and HEDIS Record Requests

South Carolina Medicaid managed care organizations (MCOs) request medical records from providers to comply with the requirements the South Carolina Department of Health and Human Services (SCDHHS) has for reporting Healthcare Effectiveness Data and Information Set (HEDIS®). Please cooperate with the MCOs' medical record requests and ensure that any medical record vendors do so as well, and/or provide the means through which an MCO may access medical records of Medicaid members. Generally, access to medical records is included in network contracts.

Policy for Prescribing, Dispensing and Administering Controlled Substances

South Carolina Governor Henry McMaster issued Executive Order No. 2017-43, setting a five-day limit for certain opioid prescriptions and a supplemental requirement for the South Carolina Department of Health and Human Services (SCDHHS) to articulate opioid dosing guidelines in policy.

The five-day limit is for initial opioid prescriptions for acute and post-operative pain management. The policy will provide exceptions when clinically indicated. Additionally, SCDHHS will recommend best practices that require legislative or regulatory action to the Opioid Emergency Response Team.

2018 Provider Enrollment Application Fee

The Centers for Medicare and Medicaid Services (CMS) has announced the enrollment application fee amount for calendar year 2018 will be $569. This fee is required with any applicable Healthy Connections Medicaid provider enrollment application submitted on or after Jan. 1, 2018, and on or before Dec. 31, 2018.

Free Provider Workshops: December 2017-February 2018

Below is a schedule of the free provider workshops offered by the South Carolina Department of Health and Human Services (SCDHHS), including Medicaid Basics, Comprehensive Web Tool and Claim-level Adjustments and Third-Party Liability.

To attend these training sessions, you may register through the Healthy Connections Medicaid Provider Education website, Medicaidelearning.com, or call the Provider Service Center at 1 (888) 289-0709 and select option 1 from the main menu.

 

Medicaid Basics 

Dec. 12, 10 a.m.-4 p.m., Columbia 

November 2017 Provider Payment Holiday Schedule

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 one week in November in order to accommodate the 2017 holiday schedule.
 
Due to the Thanksgiving holiday, Saturday, Nov. 18, at 5 p.m. is the final day to submit claims for payment date Friday, Nov. 24. Payments will run Monday, Nov. 20, and electronic remittance advices will be available Tuesday, Nov. 21. Payments will be dated Friday, Nov. 24, as usual.
 

Children’s Private Duty Nursing Staffing Requirement Change

The South Carolina Department of Health and Human Services (SCDHHS) is revising its staffing requirements for the Children's Private Duty Nursing Program.

Effective Oct. 1, 2017, in lieu of having one year of pediatric nursing experience in a clinical setting, nursing providers may submit a pediatric nurse training program for registered nurses (RNs) and licensed practical nurses (LPNs) to SCDHHS for review and potential approval.

New Centralized Intake Call Center Phone Number

The South Carolina Department of Health and Human Service (SCDHHS) Community Long Term Care (CLTC) centralized intake call center telephone number will change to (888) 971-1637, effective Monday, July 31, 2017.

This call center is used to make referrals for long term care waiver services, Children's Personal Care Service, nursing home placement, nursing facility conversion, incontinence supplies, the Home Again program, Pre-admission Screening Resident Review (PASRR) and the Tax Equity and Fiscal Responsibility Act (TEFRA), also known as Katie Beckett children's Medicaid.

Autism Spectrum Disorder Prior Authorizations for 0359T

The South Carolina Department of Health and Human Services (SCDHHS) seeks to clarify the authorized services outlined in the updated prior authorization letters that were sent to parents/guardians/caregivers for new autism spectrum disorder (ASD) state plan services in early July. The behavior assessment code of 0359T was not included in the authorization letters.

Autism Spectrum Disorder Interpreter and Translation Services

The South Carolina Department of Health and Human Services (SCDHHS) seeks to clarify the process for fee-for-service (FFS) beneficiaries receiving autism spectrum disorder (ASD) services and in need of interpreter and translation services. ASD providers may continue to utilize interpreter services through the South Carolina Department of Disabilities and Special Needs (SCDDSN) as they have in the past.

July 2017 Regional OSS and OSCAP Provider Trainings

 

The South Carolina Department of Health and Human Services (SCDHHS) Division of Community and Facility Services will host four regional trainings on updates to the policies and procedures for Optional State Supplementation (OSS) and Optional Supplemental Care for Assisted Living Participant (OSCAP) providers. These trainings, scheduled in July, are for any Community Residential Care Facility (CRCF) currently enrolled as an OSS provider and for those contracted OSCAP providers.

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