Why are our claims denying for dates of service prior to the individual provider leaving the practice?Prior to requesting the removal of an Individual provider from your group practice ensure that the pending claims are adjudicated. However, if the provider has already been removed from the group prior to the claim(s) being adjudicated and needs to be added back to the group, submit the request on the business letterhead with the provider’s or an authorized signature via Fax: (803) 870-9022 or Mail: Medicaid Provider Enrollment, PO Box 8809, Columbia, SC 29202-8809. Updates will be processed within ten (10) days of receipt. |
Does the Nursing Facility (NF), Intermediate Care Facility (ICF) / Mental Retardation (MR) or Swing Bed facility have to wait for a denial from DHHS before submitting an invoice to the hospice agency?Yes. The denial must be attached. |
Will the hospice agency receive a copy of the DHHS Form 181 when the recurring income changes?Yes, they will receive a copy of the 181 to verify the income change. It is recommended that the NF or ICF/MR attach a copy of the most current 181 when invoicing the hospice. Recurring income is noted in Section III of DHHS Form 181. Medicaid Eligibility is responsible for determining recurring income. |
Can you send me a copy of the Remittance Advice (RA)?Copies of Remittance Advice statements can be retrieved online via the Web Tool. If the remittance advice date is not available, complete a Duplicate Remittance Advice Request Form in the Forms Section of all provider manuals. There is a processing fee of $20 plus 20 cents per page copied. The charges will be deducted from a future Remittance Advice, appearing as a debit adjustment. The duplicate RA policy was enacted in December 2010. |
Can you correct a Web Tool claim online?Yes; this can be done by submitting a new claim. |
Can you resubmit the same claim via the Web Tool?Yes, if you submit a new claim, you will get a new CCN. |
If you make an error and you submit the claim on the Web Tool, is there a way to cancel or make a correction that same day?Once a claim is submitted via the Web Tool, there is no way to cancel or make a correction to the submitted claim that same day. Once the claim has gone through the payment cycle, you will be able to see if the claim has been rejected, paid, or suspended. You will then be able to make corrections to the claim before resubmitting as a new claim. |
Where can I attach documentation to my Web Tool claim?On the Claim Entry screen, go to the Document tab to attach your documentation. (Effective August 17, 2015) Claims Attachments – Web Tool Reference Guide. |
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 |
What is provider revalidation?All enrolled South Carolina Healthy Connections Medicaid providers who are not Durable Medical Equipment (DME) suppliers must revalidate their enrollment criteria every five years in accordance with the Affordable Care Act. DME suppliers must revalidate every three years. Revalidation FAQs PDF |