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Bulletins and Information for All Medicaid Providers

Implementation of 5010 Transaction Standards


The South Carolina Department of Health and Human Services (SCDHHS) will begin processing 5010 transactions January 1, 2012, as mandated.

On November 17, 2011, the Centers for Medicare and Medicaid Services (CMS) announced a 90-day delay in enforcement of the new 5010 transactions standards. Although enforcement of compliance to ASC X12 5010 Version 5010 and NCPDP D.0 was delayed until March 31, 2012, the mandatory compliance date remains January 1, 2012.

Implementation Schedule and Important Dates:


Alcohol and Drug Testing Policy


Effective with dates of service on or after December 1, 2011, the South Carolina Department of Health and Human Services (SCDHHS) will implement limitations on Alcohol and Drug Screens.  For the complete policy and billing instructions, please see the Physician, Laboratories and Other Medical Professionals manual located at


Medicaid Insurance Verification Services (MIVS) - Third Party Liability (TPL) Support Services


Effective November 1, 2011, the Medicaid Insurance Verification Services (MIVS) contract will no longer be administered by Affiliated Computer Services, Inc.  Blue Cross Blue Shield of South Carolina (BCBSSC) will be performing the following services on behalf of the South Carolina Department of Health and Human Services (SCDHHS):


October 2011 Bulletin Archive

Price Increase For Synagis® Injectable
Description: Effective For Dates Of Service On Or After October 15, 2011, The South Carolina Department Of Health And Human Services (SCDHHS) Will Increase The Rate For Synagis To The Current Average Wholesale Price (AWP) Minus 18%.
Posted: 10/13/2011 4:12:48 PM

August 2011 Bulletin Archive

Providers Indicated
Description: National Correct Coding Initiative

SCDHHS Announces Use of National Correct Coding Initiative (NCCI) on a Prepayment Basis


NCCI Background and FAQs

Initially National Correct Coding Initiative (NCCI) was developed by CMS for Medicare Part B claims and is now being implemented for state Medicaid programs.

July 2011 Bulletin Archive

Durable Medical Equipment (DME) Providers
Description: Changes In Policies And Procedures For Providing Incontinence And Other Waiver Supplies And Services

Final Notice Of Action

Payment to Medicaid Providers Reduced and Beneficiary Co-payments Increased July 11, 2011
The South Carolina Department of Health and Human Services (SCDHHS), as required by
Federal Regulations of Title 42 Part 447 Section 205, gives final notice of the following actions
regarding its methods and standards for paying providers and beneficiary cost sharing under the
State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Medicaid Reimbursement Changes

The South Carolina Department of Health and Human Services (SCDHHS) announces the
following changes to maintain expenditures within budget appropriations for State Fiscal Year
2012. Public Notice of the proposed changes was published June 6, 2011. Comments were
accepted and considered through 5:00 p.m. July 6, 2011. The reductions in this notice are in
addition to the previous reduction of 3% that was applied on April 8, 2011.


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