All Providers

Bulletins and Information for All Medicaid Providers

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:

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.

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