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Bulletins and Information for All Medicaid Providers

Transition to the CMS-1500 Health Insurance Claim Form (02-12) version

In response to guidelines recommended by the National Uniform Claim Committee (NUCC) and set forth by the Centers for Medicare and Medicaid Services (CMS), the South Carolina Department of Health and Human Services (SCDHHS) is implementing the revised CMS-1500 Health Insurance Claim Form (02-12) version effective January 6, 2014.

Although the CMS-1500 form (02-12) is effective January 6, 2014, use of the revised form is optional until March 31, 2014.  The transitional dual acceptability period of the current and the revised forms is described as follows:

Tetanus, Diphtheria and Pertussis (Tdap) Vaccine


Medical providers who “buy and bill” for the Tdap vaccine should use the Current Procedural Terminology (CPT) code 90715.  For administration of the vaccine, providers should bill CPT code 90471 or 90472, as appropriate. 

Tdap vaccines will also be covered through the pharmacy benefit for adult beneficiaries, so long as a prescription is provided for the vaccine.  Pharmacy providers should submit claims for the Tdap vaccine through the point-of-sale (POS) system. 

Managed Care Organizational Changes. Explanation of the Organizational Changes

  1. Managed Care Organizational Changes

Effective January 1, 2014, all current Medical Home Networks (MHN) Plans operating within the state will become Managed Care Organizations (MCO) either through acquisition or conversion.

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:

Managed Care Organizational Change, Clarification of Changes

I.              Managed Care Organizational Change

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.


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