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Bulletins and Information for All Medicaid Providers

Rehabilitative Behavioral Health Services Frequently Asked Questions

On Feb. 20, the South Carolina Department of Health and Human Services (SCDHHS) released a bulletin on changes to the Rehabilitative Behavioral Health Services (RBHS) policy, effective March 1, 2015. These changes, which only apply to fee for service, include medical necessity and prior authorizations, staff credentials, staff to client ratio, frequency limits and reimbursement rates and modifier changes.

For a list of answers to commonly asked questions on these RBHS service changes, please visit scdhhs.gov/rbhsfaq.

Primary Care Physician Fee Schedule Enhancement

The South Carolina Department of Health and Human Services (SCDHHS) recently published bulletins dated on Nov. 26, 2014, and Dec. 31, 2014, regarding fee schedule enhancements for qualifying primary care physician specialties. Previous bulletins only listed the fee schedule for services performed in a non-facility setting by qualifying providers.

Healthy Connections Checkup: Colorectal Cancer Screening Benefits

Effective immediately, the following codes are now billable under the Healthy Connections Checkup (Checkup) colorectal cancer screening benefit. These services are available once every 10 years for patients 50-75 years old. An FP modifier must be appended to the following Current Procedural Terminology (CPT) codes.

RBHS Provider Enrollment Moratorium

Effective immediately the South Carolina Department of Health and Human Services (SCDHHS) is imposing a moratorium on the enrollment of Rehabilitative Behavioral Health Services providers. On February 5, 2015, 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.

642 Edit Claims

Multiple hospitals have reported unusually high volumes of claims rejecting with a 642 edit. At this time, the South Carolina Department of Health and Human Services (SCDHHS) believes there is a technical issue causing an error with the claims processing system and it is unable to capture this deductible and copay information. SCDHHS is currently researching the problem and hopes to have a fast and accurate resolution. More information will be released as it develops.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

Change in SC P&T Committee Meeting Date

The South Carolina Healthy Connections Medicaid Pharmacy and Therapeutics Committee meeting scheduled for Wednesday, Feb. 4, 2015, has been changed to Wednesday, Mar. 4, 2015. The meeting location and time will remain the same:

South Carolina Medicaid Pharmacy and Therapeutics Committee
Location: South Carolina Pharmacy Association (SCPhA) Office
1350 Browning Road, Columbia, SC 29210 

Wednesday, Mar. 4, 2015, 4 p.m.

FINAL NOTICE Address Change for SFTP-Based Medicaid Claims

Beginning Wednesday, Jan. 28, 2015, at 8 a.m. EST, the South Carolina Department of Health and Human Services (SCDHHS) will finalize its transition to a new Secure File Transfer Protocol (SFTP)-based Medicaid claims submission system.

Earlier in 2014 notifications were issued to providers when SCDHHS completed the initial backend migration to this new system. This is the Final Notice that the legacy addresses are now being retired. All SFTP-based Medicaid claims should be transmitted to:

claims.scdhhs.gov or 130.127.205.18

Provider Enrollment and Screening

The Centers for Medicare and Medicaid Services (CMS) has announced the Enrollment Application fee amount for calendar year 2015 will be $553.00. This fee is required with any applicable Healthy Connections Medicaid provider enrollment application submitted on or after January 1, 2015, and on or before December 31, 2015.

Sickle Cell Disease Management Program

Effective on or after January 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will update its Disease Management program to include sickle cell disease. Sickle Cell Disease Management (SCDM) is available to Medicaid eligible individuals determined to have a confirmed diagnosis of sickle cell disease as defined by the Centers for Disease Control and Prevention (CDC) and are not simultaneously receiving Targeted Case Management or any other coordination/management service for sickle cell disease.

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