All Providers

Bulletins and Information for All Medicaid Providers

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.

Online Medicaid Eligibility Application Weekly Database Maintenance from 10 p.m.-2 a.m.

We are performing weekly maintenance or updates on our online application system beginning at 10 p.m. Thursday. We anticipate service will be restored by 2 a.m. Friday.

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:

ICD 10 Clinical Modification Procedure Coding System

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.

A claim with a Date of Service or Date of Discharge before Oct. 1, 2015, must contain ICD-9 code(s). A claim submitted with ICD-9 code(s) after Oct. 1, 2015, must have a service date before Oct. 1, 2015.

Provider Revalidation

In the bulletin dated April 20, 2015, providers were informed their enrollment information must be revalidated, per the Centers for Medicare and Medicaid Services (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 a revalidation enrollment application 30 days from the date of your official revalidation notification letter. DO NOT begin the revalidation process until you receive notification.

Claim Submission Web Portal (Webtool) Enhancement

Beginning Aug. 17, 2015, the electronic claim submission web portal (Webtool) will be enhanced to allow the attachment of documentation to claims at the following link: https://portal.scmedicaid.com/login. In an effort to simplify the administrative process of Medicaid claim submission, providers submitting claims electronically through the Webtool will now be able to attach image files in .jpeg, .tiff and .pdf formats to their claim. This will allow more electronic claim submissions and decrease the need for hard-copy claim submissions.

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