All Providers

Bulletins and Information for All Medicaid Providers

Coverage of Drug Testing Codes

Effective for dates of service beginning Jan. 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will cover the following presumptive and definitive drug testing codes at the reimbursement rates as stated in the attached table. SCDHHS will reimburse for a maximum of one screening per procedure code per date of service, not to exceed 18 screenings per 12-month period. Providers should bill the most appropriate Healthcare Common Procedure Coding System (HCPCS) code for the service rendered.

 

New Medicaid Cards

The South Carolina Department of Health and Human Services (SCDHHS) announces the release of a new Healthy Connections Medicaid card template. The new card, effective August 1, 2016, will no longer contain a magnetic data strip on the backside. The new cards will go into circulation for current members who request replacement cards and newly-eligible members. Section 1 of provider manuals contain Medicaid card language and front and back images of cards.

Compliance with Federal Non-discrimination Requirements

Per guidance from the US Department of Health and Human Services' Office of Civil Rights, and effective Aug. 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will begin assessing provider compliance with all non-discrimination requirements found in:

Changes to the SCDHHS Preferred Drug List Effective July 1, 2016

Beginning with dates of service on or after July 1, 2016, the following changes will become effective for the South Carolina Department of Health and Human Services (SCDHHS) Preferred Drug List (PDL).  

OTIC ANTIBIOTICS

Preferred

Non-Preferred

 

Ofloxacin†

 

Moved to Non-Preferred

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.

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