All Providers

Bulletins and Information for All Medicaid Providers

Provider Revalidation Group 5

In the bulletin dated April 20, 2015, providers were informed their enrollment information must be revalidated, per the Centers for Medicare and Medicaid Service (CMS). To avoid risk of termination in the South Carolina Department of Health Human Services (SCDHHS) Healthy Connections Medicaid program, you must complete and submit an enrollment application 30 days from the date of your official revalidation notification letter. DO NOT begin the revalidation process until you receive notification.

Medicaid Targeted Case Management Service Review Process

The South Carolina Department of Health and Human Services (SCDHHS) will implement a review process on Medicaid Targeted Case Management Services (MTCM) rendered by private providers of MTCM. Effective Nov. 1, 2015, SCDHHS will reimburse for no more than 24 units per calendar quarter per beneficiary unless medical necessity has been demonstrated and approved through the prior authorization process defined in the Oct. 1, 2015, edition of the MTCM Provider Manual. The 24-unit allowance applies to any combination of face to face or telephonic MTCM.

Access to Records Concerning Medicaid Services and Payment

This is a reminder that, as a condition of participation in the Healthy Connections Medicaid program, providers are required to maintain and provide access to records. These records should fully disclose the medical necessity for treatment and the extent of services provided to Medicaid beneficiaries. Unless program policy otherwise allows, this documentation must be present in the beneficiaries' records before the provider files claims for reimbursement.

Provider Revalidation: Group 4

In the bulletin dated April 20, 2015, providers were informed their enrollment information must be revalidated, per the Centers for Medicare and Medicaid Service (CMS). To avoid risk of termination in the South Carolina Department of Health Human Services (SCDHHS) Healthy Connections Medicaid program, you must complete and submit an enrollment application 30 days from the date of your official revalidation notification letter. DO NOT begin the revalidation process until you receive notification.

ICD-10 October Compliance Date Approaches

On Oct. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) transitions from International Classification of Diseases, 9th Edition (ICD-9) to International Classification of Diseases, 10th Edition (ICD-10) as the medical code set for medical diagnosis and inpatient hospital procedures. Providers not using valid ICD-10 codes beginning Oct. 1, 2015, will be unable to successfully bill for services.

ICD-10 Provider Readiness Survey

Are you ready for the launch of International Classification of Diseases, Tenth Edition (ICD-10)? 
 
Effective Oct. 1, 2015, claims submitted to the South Carolina Department of Health and Human Services (SCDHHS) must include ICD-10 diagnosis or inpatient procedure codes for any claim with a Date of Service or Date of Discharge on or after Oct. 1, 2015. 

Provider Revalidation: Group 3

In the bulletin dated April 20, 2015, providers were informed their enrollment information must be revalidated, per the Centers for Medicare and Medicaid Service (CMS). To avoid risk of termination in the South Carolina Department of Health Human Services (SCDHHS) Healthy Connections Medicaid program, you must complete and submit an enrollment application 30 days from the date of your official revalidation notification letter. DO NOT begin the revalidation process until you receive notification.

ICD Indicator for Claims Submitted on CMS 1500 Form

 

Effective Oct. 1, 2015, Field 21 of the CMS 1500 form will require an indicator of “9” or “0.” This indicator is for the purposes of the ICD-10 implementation. Entering a “9” will indicate the provider intends to submit ICD-09 codes. Entering a “0” will indicate the provider intends to submit ICD-10 codes. Below is a guide for provider claim staff.

Health Insurance Premium Payment (HIPP) Program to Cover Monthly Individual Health Insurance Premiums for Eligible Medicaid Beneficiaries

Effective on or after Sept. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) Health Insurance Premium Payment (HIPP) program will expand to pay the premiums for Healthy Connections Medicaid beneficiaries enrolled in individual health insurance policies. Currently, the HIPP program will only cover premiums for group health insurance. To qualify for payment under the HIPP program, the cost of the individual health insurance policy must meet the Department's cost-effectiveness criteria.

Nutritional Counseling Bulletin.

I.Nutritional Counseling

Effective Aug. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will implement a policy for nutritional counseling. This policy specifically targets those individuals with a Body Mass Index (BMI) of 30 and greater who are currently not seeking gastric bypass surgery or related services.

The nutritional counseling program will exclude the following categories of Healthy Connections members:

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