Who is mandating the provider revalidation process?This implementation is in response to directives in the standards established by Section 6401(a) of the Affordable Care Act (ACA) in which CMS requires all state Medicaid agencies to implement the provider enrollment, screening, and revalidation provisions of the Affordable Care Act. These regulations were published in the Federal Register, Vol. 76, February 2, 2011, and were effective March 25, 2011. Revalidation FAQs PDF |
Will I need a site visit?All moderate and high risk providers will need a site visit. The site visit must occur within 30 days from the date on the revalidation notification letter. Revalidation FAQs PDF |
Will there be training available for the South Carolina Healthy Connections Medicaid provider revalidation process?There will be webinars, e-learning opportunities, and classroom training sessions available. For information about dates, times and registration, please visit medicaidelearning.remote-learner.net. Revalidation FAQs PDF |
Can a billing provider be an ordering or referring provider as well?Yes, as long as the provider is not designated as an ordering/referring provider exclusively. Future edits will prevent claims payment if an ordering/referring-only provider submits their NPI as a billing provider. |
Can a provider be moved from one risk category to another?Yes, providers can be reassigned from the “limited” or “moderate” categories due to:
|
How are providers categorized by risk categories?Three levels of screening (limited, moderate and high) are recognized for those provider types that are also recognized provider or supplier types under Medicare. For those provider types that are not recognized under Medicare, SCDHHS has assessed the risk of fraud, waste and abuse using similar criteria to those used in Medicare. See the list below for SCDHHS risk categories: Limited Risk: (State-regulated and State-licensed would generally be categorized as limited risk)
Moderate Risk: (Highly dependent on Medicare, Medicaid and CHIP to pay salaries and other operating expenses and which are not subject to additional governmental or professional oversight and would be considered moderate risk)
High Risk: (Identified by the State as being especially vulnerable to improper payments and would be considered as high risk)
|
How can a provider check to see if the ordering/referring physician is enrolled with Medicaid?
On the SCDHHS website SCDHHS.gov, there is a searchable listing of Enrolled Providers under the For Providers tab. If the provider is not listed, then the provider is not currently enrolled with Medicaid. You may also contact the Provider Service Center at 1 (888) 289-0709, option 4 to verify the provider’s enrollment.
|
How can I obtain more information regarding the new provider screening and other enrollment requirements?A link to the Federal Register, Vol 76, No. 22, dated February 2, 2011, can be found on the SCDHHS website at SCDHHS.gov. |
What are some of the new provider screening and enrollment guidelines?
|
What is a Temporary Moratorium?A temporary moratorium is the imposition of a hold or freeze on the enrollment of new or initial Medicaid providers and suppliers of a particular provider type or the establishment of new practice locations of a particular provider type in a specific geographic area for a period of six months. CMS may extend a temporary moratorium in six month increments. The announcement of a moratorium will be reported in the Federal Register. |