All Providers

Bulletins and Information for All Medicaid Providers

Coverage of Bariatric Surgery

Effective with dates of service on or after July 1, 2016, the South Carolina
Department of Health and Human Services (SCDHHS) will expand the bariatric
surgery benefit to include coverage of sleeve gastrectomy. Coverage for bariatric
surgery is limited to those members who demonstrate medical necessity based on
InterQual® criteria, and prior authorization is required.
 
For information on submitting a prior authorization request for a fee-for-service

Payment Error Rate Measurement (PERM)

The Improper Payments Information Act of 2002 directs federal agency heads, in accordance with the Office of Management and Budget (OMB) guidance, to review annually, programs that are susceptible to significant erroneous payments and report the improper payment estimates to Congress. OMB identified Medicaid and Children's Health Insurance Program (CHIP) as programs at risk for erroneous payments.

May 2016 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 May 2016 in order to accommodate the South Carolina state holiday schedule.

During the week beginning May 8, 2016, payments will run Monday, May 9, and electronic remittance advices will be available Tuesday, May 10. Payments will be dated Friday, May 13, as usual. Saturday, May 7, at 5 p.m. is the final day to submit claims for payment date Friday, May 13.

Medicaid Targeted Case Management (MTCM) Moratorium

Effective immediately the South Carolina Department of Health and Human Services (SCDHHS) is imposing a moratorium on the enrollment of Medicaid Targeted Case Management (MTCM) providers. On March 2, 2016, SCDHHS received concurrence from the Centers for Medicare and Medicaid Services (CMS) to exercise the agency's authority under Section 1902 of the Social Security Act and regulations at 42 CFR 455.470 to impose this moratorium.

Required use of the South Carolina Reporting & Identification Prescription Tracking System (SCRIPTS)

Beginning with dates of service on or after April 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will require that providers verify Medicaid members' controlled substance prescription history through the South Carolina Reporting & Identification Prescription Tracking System (SCRIPTS) before issuing a prescription for any Schedule II through IV controlled substance.

Resources for Background Checks

On Nov 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) strengthened the criminal background check portion of the Rehabilitative Behavioral Health Services (RBHS) manual. Below are resources for providers to use to conduct background checks.

Ambulance Services Provider Manual Update

The South Carolina Department of Health and Human Services (SCDHHS) will update sections three and four of the Ambulance Services Provider Manual. The update will make a clear distinction between the current requirements for submitting claims with modifiers and origin/destination codes. The previous policy uses the term "modifier" to describe the CMS 1500 billing codes (76 - Duplicate procedure on the same day of service; NT - No Transport and EV - Evacuation) as well as the Agency's origin and destination alpha characters.

Updates to Section 1 - All Provider Manuals

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Effective Jan. 1, 2016, Section 1 of all South Carolina Medicaid Provider Manuals have been updated to reflect changes to the following policies:

SOUTH CAROLINA MEDICAID PROGRAM

Program Description - Page 1

SC Healthy Connections Medicaid Card(s) - Pages 3-5

 

RECORDS/DOCUMENTATION REQUIREMENTS

General Information  - Pages 12-14

Signature Policy - Pages 14-16

 

MEDICAID PROGRAM INTEGRITY

Program Integrity - Pages 30-33

 

2016 Provider Enrollment Application Fee

The Centers for Medicare and Medicaid Services (CMS) has announced the enrollment application fee amount for calendar year 2016 will be $554.00. This fee is required with any applicable Healthy Connections Medicaid provider enrollment application submitted on or after Jan. 1, 2016, and on or before Dec. 31, 2016.

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