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Bulletins and Information for All Medicaid Providers

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.

Ambulance Services Provider Manual Update

The South Carolina Department of Health and Human Services (SCDHHS) will update sections three and four of the Ambulance Services Provider Manual. The update will make a clear distinction between the current requirements for submitting claims with modifiers and origin/destination codes. The previous policy uses the term "modifier" to describe the CMS 1500 billing codes (76 - Duplicate procedure on the same day of service; NT - No Transport and EV - Evacuation) as well as the Agency's origin and destination alpha characters.

Updates to Section 1 - All Provider Manuals

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Effective Jan. 1, 2016, Section 1 of all South Carolina Medicaid Provider Manuals have been updated to reflect changes to the following policies:

SOUTH CAROLINA MEDICAID PROGRAM

Program Description - Page 1

SC Healthy Connections Medicaid Card(s) - Pages 3-5

 

RECORDS/DOCUMENTATION REQUIREMENTS

General Information  - Pages 12-14

Signature Policy - Pages 14-16

 

MEDICAID PROGRAM INTEGRITY

Program Integrity - Pages 30-33

 

2016 Provider Enrollment Application Fee

The Centers for Medicare and Medicaid Services (CMS) has announced the enrollment application fee amount for calendar year 2016 will be $554.00. This fee is required with any applicable Healthy Connections Medicaid provider enrollment application submitted on or after Jan. 1, 2016, and on or before Dec. 31, 2016.

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.

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