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Bulletins and Information for All Medicaid Providers

Changes to BabyNet Services Claims Payment Process

For payment dates effective July 1, 2018, the South Carolina Department of Health and Human Services (SCDHHS) will transition claims payment for BabyNet services from Jasper County Disabilities and Specials Needs (DSN) Board to SCDHHS. Providers must be registered in the South Carolina Enterprise Information System (SCEIS) before July 1, 2018, to avoid payment delays during this transition.

Rate Increase for Applied Behavior Analysis (ABA)

Effective on or after July 1, 2018, the South Carolina Department of Health and Human Services (SCDHHS) will increase reimbursement for Applied Behavior Analysis (ABA) provided by a Registered Behavior Technician (RBT) to $15.50 per 30 minutes ($31 per hour).

Healthy Connections Choices Enrollment Broker Training

The South Carolina Department of Health and Human Services (SCDHHS), in partnership with the state's contracted enrollment broker, MAXIMUS, will facilitate a series of provider training sessions throughout the state in May and September.

New Medicare ID Cards

Starting in April 2018, the Centers for Medicare and Medicaid Services (CMS) will issue new Medicare identification (ID) cards. 

The new cards will replace the Social Security Number-based Health Insurance Claim Number (HICN) currently on the card with a unique Medicare Beneficiary Identifier (MBI) to protect people with Medicare from identity theft. 

2018 Provider Revalidation

The South Carolina Department of Health and Human Services (SCDHHS) is beginning 2018 provider revalidation. Providers who enrolled as a Healthy Connections Medicaid provider between Dec. 1, 2012-Dec. 31, 2013, are scheduled for revalidation in 2018. 

Medicaid Periodicity Schedule

To ensure the highest quality care to children enrolled in the South Carolina Medicaid program, the South Carolina Department of Health and Human Services (SCDHHS) adopts the following updates and reminders regarding Early and Periodic Screening, Diagnosis and Treatment (EPSDT) coverage policy. The EPSDT benefit is available to Medicaid beneficiaries under the age of 21.

Medical Periodicity Schedule

HEDIS® Tips

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®). Thank you for cooperating with the MCOs' medical record requests and ensuring that any medical record vendors do so as well.

Tips to Avoid Noncompliance and Boost HEDIS Rates

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.

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