All Providers

Bulletins and Information for All Medicaid Providers

Medicaid Payment for Services Provided Without Charge (Free Care)

The Centers for Medicare and Medicaid Services (CMS) recently amended policies regarding Medicaid reimbursement to Medicaid providers for the delivery of state plan-approved services that are available to Medicaid eligible beneficiaries, without charge to the beneficiary (including services that are available without charge to the community at large, or "free care"). The goal of this change is to enhance the health of communities through improved access to quality health care services.

Medicaid Status Inquiry/Release of Information Requirement

 

The South Carolina Department of Health and Human Services (SCDHHS) offers multiple methods to submit Healthy Connections Medicaid eligibility enrollment and eligibility application status requests. Providers may use one of the methods listed below to verify Medicaid enrollment or verify the status of an individual's application.

Free Provider Workshops: November-December 2015

Below is a schedule of the free provider workshops offered by the South Carolina Department of Health and Human Services to include Medicaid Basics, Comprehensive Web Tool, Web Tool Updates and Third Party Liability.

To attend these training sessions, you may register through the Healthy Connections Medicaid Provider Education website at Medicaidelearning.com or by calling the Provider Service Center at 1 (888) 289-0709. From the main menu, select option 1.

Medicaid Basics

Nov. 5, 10 a.m.-4 p.m., Columbia
Dec. 3, 10 a.m.-4 p.m., Columbia

2015 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 two weeks in November and one week in December in order to accommodate the 2015 holiday schedule.

Due to Veteran's Day, Saturday, Nov. 7, at 5 p.m. is the deadline to submit claims for payment date Friday, Nov. 13. Payments will run Monday, Nov. 9, and electronic remittance advices will be available Tuesday, Nov. 10. Payments will be dated Friday, Nov. 13, as usual.

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.

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