All Providers

Bulletins and Information for All Medicaid Providers

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.

SCDHHS and KEPRO to Hold Provider Quality Improvement Training

The South Carolina Department of Health and Human Services (SCDHHS) will co-sponsor provider and facility training with the Keystone Peer Review Organization (KEPRO), the SCDHHS Quality Improvement Organization. The annual quality improvement training includes requirements, updates and a review of the process and procedures for prior authorization.

Deemed Baby Process

The South Carolina Department of Health and Human Services (SCDHHS) implemented a new eligibility system in November. Throughout the launch, SCDHHS worked diligently to ensure the Agency provided timely and accurate eligibility determinations.  

During the system changeover, there was a delay in the completion of final determinations. SCDHHS continues to process applications and aims to be completely in the new system, resuming standard eligibility determination turnaround times, in the next few weeks. 

Co-payments

The South Carolina Department of Health and Human Services (SCDHHS) has amended the Schedule of Co-payments found in the appendix section of all manuals. The schedule now includes all Current Procedural Terminology (CPT) and Healthcare Current Procedural Coding System (HCPCS) codes that a provider has the option to charge and collect co-payments from a Healthy Connections member. The chart can be found in the appendix section of all manuals.

ACA Enhanced Physician Payment Reimbursement Discontinued. Primary Care Fee Schedule Enhancement

ACA Enhanced Physician Payment Reimbursement Discontinued December 31, 2014

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented a portion of the final rule under the Affordable Care Act (ACA) that increased Medicaid reimbursements for evaluation, management and immunization procedure codes for two years. The increase applied to both fee-for-service (FFS) and Medicaid Managed Care Organizations (MCOs).

Intensive Family Services Contact

For questions or comments regarding the bulletin, Intensive Family Services (Procedure Code H0046), posted November 17, please contact the Provider Service Center at (888) 289-0709.

Claim Reconsideration Policy-Fee For Service (FFS) Medicaid

Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Claim Reconsideration Policy directives will be located in all Provider Manuals in Section 3, Billing Procedures. When requesting a reconsideration, providers must adhere to all applicable policies, timely filing limits, and must comply with the following procedures:

Policy Revisions to the Local Education Agency (LEA) Services Manual for Rehabilitative Behavioral Health Services (RBHS)

The South Carolina Department of Health and Human Services (SCDHHS), Division of Behavioral Health, will revise the Local Education Agency (LEA) manual for the Rehabilitative Behavioral Health Services (RBHS) policy section to discontinue use of the FORM 255 as of November 1, 2014. The Department of Education will continue to ensure the LEAs track the referral process for Psychological Testing and Evaluation.

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