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Bulletins and Information for All Medicaid Providers

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 November in order to accommodate the 2016 holiday schedule.

Due to Thanksgiving, Saturday, Nov. 19, at 5 p.m. is the final day to submit claims for payment date Friday, Nov. 25. Payments will run Monday, Nov. 21, and electronic remittance advices will be available Tuesday, Nov. 22. Payments will be dated Friday, Nov. 25, as usual.

Modification To Codes That Require Filing To Third-Party Insurers

Effective for dates of service on or after Jan. 1, 2017, and as required by federal regulation, the South Carolina Department of Health and Human Services (SCDHHS) will implement cost-avoidance rules for the procedure codes reflected below. Service providers will be required to file the claim to any third-party insurer before the claim submission to SCDHHS for payment. Claims filed with SCDHHS with the procedure codes reflected below, before billing all third-party insurers, will receive all applicable claim edits.

Accreditation Requirement Deadline Extension

The South Carolina Department of Health and Human Services (SCDHHS) has extended the deadline for site and service accreditation requirements for Rehabilitative Behavioral Health Services (RBHS) providers to Oct. 31, 2017.

Please see the current RBHS provider manual for the updated crosswalk of services by accrediting organizations.

Thank you for your continued support of the Medicaid program.

Deadline for Provider Revalidation is Sept. 24; Provider Termination is Sept. 25

Federal regulations mandate that the South Carolina Department of Health and Human Services (SCDHHS) revalidate the enrollment of all providers serving Medicaid beneficiaries. In accordance with this federal mandate, South Carolina Healthy Connections Medicaid providers that have not completed and submitted the provider enrollment revalidation application will be terminated Sept. 25, 2016.

Filing Advicare Advocate Claims

On June 1, 2016, Advicare Corp., a managed care organization in South Carolina, was purchased by WellCare Health Plans, Inc. As a result of this purchase Advicare Advocate, Advicare's Medicare-Medicaid Plan (MMP), will no longer participate in the Healthy Connections Prime program. Effective Sept. 1, 2016, existing Advicare Advocate members will have new health insurance, either with another MMP or traditional Medicare and Healthy Connections Medicaid.

Provider Manual Updates

Beginning in October 2016, the South Carolina Department of Health and Human Services (SCDHHS) will conduct routine updates and/or corrections to the Medicaid provider manuals as they are identified. SCDHHS encourages providers to continue to review their provider manuals, paying close attention to the Change Control Record, which tracks all changes made.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

Institutional Provider Clarification

The Centers for Medicare and Medicaid Services (CMS) has provided further clarification on those identified as institutional providers. Based on this clarification, the institutional providers listed in Medicaid Alert regarding the 2016 Provider Enrollment Application Fee dated Dec. 14, 2015, has been amended. South Carolina Healthy Connections Medicaid recognizes and enrolls the following institutional 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:

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