No, your lists are sharable.

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.

No. The only information that the provider service center has is if a provider revalidation application has been completed and submitted. The provider service center cannot see if a provider has started the application process but not completed it. If you have the revalidation reference number, NPI and Medicaid ID of the provider in question, you can access the application to see if there is any work in progress. Revalidation FAQs PDF

Yes, providers can be reassigned from the “limited” or “moderate” categories due to:

• Imposition of a payment suspension within the previous 10 years
• A provider or supplier has been terminated or is otherwise precluded from billing Medicaid
• Exclusion by the OIG
• A provider or supplier has been excluded from any federal health care program
• A provider or supplier has had billing privileges revoked by a Medicaid contractor within the previous 10 years
• A provider or supplier has been subjected to a final adverse action (as defined in 42 CFR 424.502) within the past 10 years
• Instances in which CMS lifts a temporary moratorium for a particular provider or supplier type and a provider or supplier that was prevented from enrolling based on the moratorium, applies for enrollment as a Medicaid provider or supplier at any time within 6 months from the date the moratorium was lifted.

No. Batches cannot be deleted at this time.

You must have authorized signed documentation in order to add a beneficiary to your TAD. You should not add a beneficiary before the DHHS 181 is forwarded to DHHS Medicaid Eligibility for approval. Contact your Eligibility office if additional information is needed.

Yes. Key in the NPI or provider ID number and the recipient ID number and press submit.

Yes. You can check on the status of your provider revalidation application by calling the Provider Service Center at (888) 289-0709, option 4. You will need your revalidation reference number in order to check on the status of your provider revalidation application. Revalidation FAQs PDF

Yes, by entering in information in the to and from fields.

Extensions will not be granted due to the stringent timelines mandated by Federal Regulation 455.104 (b), (c), and 455450 (e). Revalidation FAQs PDF

Yes. There are certain points that are clearly defined in the provider revalidation application process where you can save your work and exit the application. An incomplete application will be deleted and unable to be recovered 30 days from the day the application was created. Revalidation FAQs PDF

The HIIRF can be faxed to Medicaid Insurance Verification Services at (803) 252-0870.

No, however the edit code listing is found in Appendix 1 of your provider manual.

Not at this time. The Lists can be sorted by who created them. 

Users in the same organization based on the provider’s NPI number will be able to see claim information entered by other users.

No, MCCS staff cannot add any information to the TAD. You can only make changes via DHHS Form 181, CRCF 01 and IPC change forms.

An authorized SNF 181 along with a separate Medicare-to-Medicaid bed hold billing 181 is required.

Yes, you can copy batches and delete selected claims.

Yes; this can be done by submitting a new claim. 

No. MCCS staff cannot make corrections to the DHHS Form 181 or CRCF 01 form.

Yes, providers must file to all other payers and then input that information (received money) on the claim form on the Web Tool. There is a place to identify the hierarchy.

Yes. Copy the claim, correct it, and submit it.

Yes, if you submit a new claim, you will get a new CCN.

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.

Yes, you may submit an adjustment through the Web Tool, even if the original claim was filed using a clearinghouse – as long as it is within 15-18 months. However, UB-04 (Institutional) billers must file adjustments in the same medium as the original claim.

All South Carolina Healthy Connections Medicaid providers will go through the provider revalidation process. The current process, however, is for all South Carolina Healthy Connections Medicaid providers who have an enrollment date 90 days prior to or on 12/03/2012. These providers are required to go through the provider revalidation process. Revalidation FAQs PDF

If you are an institutional provider as determined by CMS, you will need to pay a provider revalidation fee of $553.00 if you revalidate in 2015. The 2016 fee will be determined by CMS and will be published after it is established by CMS. If you are a provider with multiple NPIs associated with your Medicaid ID, you will need to complete a new enrollment for each non-primary NPI. You are responsible for the new enrollment fee/s. Revalidation FAQs PDF

Yes, all users must have their own individual login ID and Password to access the Web Tool.  If more than one user tries to login under the same login ID and Password, they will receive a denial message.

No. If a site visit is needed, a Provider Relations Representative will contact you. Revalidation FAQs PDF

If you are an institutional provider as determined by CMS, you will need to pay a provider revalidation fee of $553.00 if you revalidate in 2015. The 2016 fee will be determined by CMS and will be published after it is established by CMS. If you are a provider with multiple NPIs associated with your Medicaid ID, you will need to complete a new enrollment for each non-primary NPI. You are responsible for the new enrollment fees. Revalidation FAQs PDF

The MIVS credit balance reporting format is not eliminating or replacing a provider’s necessity to submit a UB-04 for claim adjustment(s).

Yes, all 50 states have been mandated to perform provider revalidation. Revalidation FAQs PDF

If the service you are providing requires the use of a diagnosis code, then you must enter the diagnosis code with your claim information. 

Yes; you can find zip codes on the US Postal Services website: www.usps.com.  Click on Look Up a Zip Code™

No, you may use other options like hard copy or vendor/clearing house.

No; Suspended means that the claim is in review. 

Yes. The denial must be attached.

No, prior authorization may not be necessary for all services. There is a field for prior authorization.

Yes

See how to resolve edit code 150 at Frequently Addressed Edit Codes.

See how to resolve edit code 953 at Frequently Addressed Edit Codes.

See how to resolve edit code 989 at Frequently Addressed Edit Codes.

See how to resolve edit code 990 at Frequently Addressed Edit Codes.

For 2015, SCDHHS must collect a $553 application fee from business organizations and entities that are enrolling in South Carolina Medicaid with an Employee Identification Number (EIN). [Note: $542 for 2014.] The fee is to be used to cover the cost of program integrity efforts including the cost of screening associated with provider enrollment processes. This fee can vary from year to year based on adjustments made pursuant to the Consumer Price Index for Urban Areas (CIP-U). The application fee will be imposed on business organizations and entities that are enrolling in South Carolina Medicaid that are: (1) initially enrolling, (2) adding a practice location and (3) revalidating enrollment information at least every five years (with the exception of DME providers, who must revalidate every three years). Providers that are EXEMPT from the application fee are: individual physicians or non-physician practitioners.

For HIPP referral, providers should contact the Medicaid Insurance Verification Services at 1-888-289-0709 option 5, option 4. The HIPP Fax is 803-462-2580.

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)

• Physician or non-physician practitioners and medical groups or clinics (excluding Physical Therapists and Physical Therapists Groups)
• Nursing Homes, Hospitals, Public and Private Community Mental Health Centers, Audiologists, Certified Nurse Midwife/Licensed Midwife, Certified Registered  Nurse Anesthetists, Anesthetist Assistants, CMS Parts A & B, Managed Care Organizations,  Licensed Marriage and Family Therapists, Licensed Professional Counselors, Licensed Independent Social Workers –Clinical Practice, Psychologists, Speech Therapists, Nurse Practitioners, Physician’s Assistants, Occupational Therapists, Physicians, Speech and Hearing Clinics, End Stage Renal Disease Clinics, DHEC Clinics, Federally Qualified Health Clinics, Federally Funded Health Clinics and Rural Health Centers, Ambulatory Surgical Centers, Diabetes Education Clinics, School Districts, Developmental Rehabilitation Clinics, Infusion Centers, Pediatric Aids Clinics, Maternal and Child Health Clinics, Dentists, Opticians, Optometrists, Podiatrist, Chiropractors, Pharmacy, Pharmacy Part D, Individual Transportation Providers, Contractual Transportation Providers , Transportation Broker,  X-Ray (not portable)

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)

• Rehabilitative Behavioral Health Services,  Physical Therapists , Comprehensive Outpatient Rehabilitation Facilities (CORFs),  Hospice Providers, Community Long Term Care (individuals and groups), Independent Laboratories, X-Ray (portable), Ambulance and Helicopter Providers
• Currently enrolled (revalidating Home Health Agencies)
• Currently enrolled (revalidating DMEPOS)

 High Risk:

(Identified by the State as being especially vulnerable to improper payments and would be considered as high risk)

• Proposed (newly enrolling) Home Health Agencies (HHAs), Suppliers of Durable Medical Equipment, Prosthetics, Orthothics and Supplies (DMEPOS)

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. 

There is no need to upload documentation. The provider will enter the required information and complete an attestation form verifying that all of the information is correct. Revalidation FAQs PDF

You can find your enrollment date by calling the Provider Service Center at (888) 289-0709, option 4. Revalidation FAQs PDF

Visit the Provider Type/ Specialty listing document found here, go to www.scdhhs.gov/provider and select the link titled “Provider Type and Specialty Listing” in the Provider Lists subsection, or please visit this link to view all provider manuals. Look in the “Billing Procedures” section of the manual or manuals that you think apply to your provider type to determine which procedures you bill for. This information will help you find your provider type. Revalidation FAQs PDF

A link to the Federal Register, Vol 76, No. 22, dated February 2, 2011, can be found on the SCDHHS website at SCDHHS.gov.

The fee can only be paid at https://ssl.sc.gov/Checkout/DHHS. The fee will be collected prior to the provider revalidation process. Revalidation FAQs PDF

If you received a batch number for the submission, then the submission reached MCCS. Go to Reports and click on the type of report that was sent (i.e.: CMS-1500, etc.). If a batch number is shown for the day and number of claims in the batch sent, the submission went through.

Contact the Provider Service Center (PSC) (888) 289-0709, option 4 for Provider Enrollment.  Please have your Reference ID number available.

A provider can verify Medical Homes Network enrollment on the eligibility section of the Web Tool under the “Beneficiary Special Program Data” section.

You will need to complete a new enrollment for every NPI associated with your Medicaid ID except for the primary NPI that is identified on the revalidation notification letter. All new enrollments need to be completed within 30 days from the date on the revalidation notification letter. To access the online provider enrollment application, copy and paste https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/ into your browser. Revalidation FAQs PDF

The provider revalidation application is available exclusively online. When it is time to revalidate your enrollment as a provider, you will receive a revalidation notification letter. You have 30 days from the date on the revalidation notification letter to complete and submit the provider revalidation application in its entirety with all current information. Revalidation FAQs PDF

Individuals can be added anytime to a group without having to pay an application fee. If an individual wants to be added to a group that is not currently enrolled, the group will have to pay an application fee and enroll. Once the group is enrolled, the individual must then request to be added to the group. If the individual provider is already enrolled in South Carolina Medicaid, submit in writing an update request to have the provider affiliated with the group. The request must be on the business letterhead to include the Group’s Medicaid Legacy ID number and the provider’s NPI number 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.   If the individual provider is currently in the process of enrolling, the provider can indicate on the online application group affiliation.

Go to the Web Tool submission page. Log in; go to claims entry/history; click on the correct batch number; click on the correct claim number; copy; click the claim type on the left; click on batch, claim; edit; scroll down to claim submission reason code; select replacement. To complete this task, you must have the original Claim Control Number (CCN).

Refer to the Provider Type/ Specialty listing document. Go to www.scdhhs.gov/provider and select the link titled “Provider Type and Specialty Listing” in the Provider Lists subsection. Revalidation FAQs PDF

Providers may send an e-mail request for Medicaid credit balance receipt confirmation to creditbalancemivs@bcbssc.com.

For questions call 1-888-289-0709 option 5, option 1.

You can find the charge for the service in your provider manual.

Contact the South Carolina Healthy Connections Medicaid Provider Service Center at 888-289-0709, option 4. It is your responsibility to ensure that your contact information is current. Customer Service Advocates cannot update your address information over the phone.

To update your address, please fax or mail a letter requesting an address change to MCCS Provider Enrollment on company letterhead. The Provider Enrollment fax number is (803) 870-9022. The address is Medicaid Provider Enrollment, P.O. Box 8809, Columbia, SC 29202-8809. The letter should include the provider’s legacy and NPI numbers, as well as the new address, along with the provider’s or an authorized person’s signature and a contact person’s name and telephone number in case there are any questions. Once the address information is updated and the revalidation notification letter is re-sent, the provider will still have 30 days from the date on the original revalidation notification letter to fully complete the provider revalidation process.

Revalidation FAQs PDF

SCDHHS requires the individual provider to send in a completed/signed W9 form with the individual’s name, SSN, address and signature. Providers are also required to complete the Disclosure of Ownership and Control Interest Statement Form.

Patients learn of updates at their enrollment anniversary dates, or you may share information with them.

Within 12 months

15 - 18 months

You have 30 days from the date on the revalidation notification letter to complete and submit your provider revalidation application in its entirety with all current information. Revalidation FAQs PDF

Enrollment applications will be processed within thirty (30) business days from the date of receipt. The thirty (30) business day timeframe may be exceeded for enrollment applications that require: additional information, a site visit, a contractual agreement, or are submitted with sanction information.

Three months.

Each provider type is different. Your provider type and your preparation before beginning the application will factor into the time it takes you to complete the provider revalidation application. The process will take a minimum of 30 minutes, but it may take several hours. Revalidation FAQs PDF

After payments process

When it is time to revalidate your enrollment as a South Carolina Healthy Connections Medicaid provider, you will receive a revalidation notification letter in the mail. The revalidation letter will contain detailed instructions for the revalidation process and a revalidation reference number that is specific to each provider. You will use this information to access the provider revalidation application online. You will need to complete and submit the provider revalidation application in its entirety with all current information. Revalidation FAQs PDF

Once the provider revalidation application is approved, provider revalidation approval notification will be emailed to the email address entered on the provider revalidation application. Revalidation FAQs PDF

Your revalidation notification letter will list all of the NPIs associated with your Medicaid ID. The revalidation notification letter will identify one NPI as being the primary NPI associated with your Medicaid ID.  Complete the provider revalidation application for the primary NPI following the standard procedure. Within 30 days from the date on the revalidation notification letter, all other NPIs attached to your Medicaid ID will need to complete an online provider enrollment application. To access the online provider enrollment application, copy and paste https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/ into your browser. This ensures that the billing process continues uninterrupted. Revalidation FAQs PDF

All medical clinics will revalidate within June, July or August 2015. If your clinic’s address information has changed recently and needs to be updated, please fax or mail a letter requesting an address change to MCCS Provider Enrollment on company letterhead. The Provider Enrollment fax number is (803) 870-9022. The address is Medicaid Provider Enrollment, P.O. Box 8809, Columbia, SC 29202-8809. The letter should include the provider’s legacy and NPI numbers, as well as the new address, along with the provider’s or an authorized person’s signature and a contact person’s name and telephone number in case there are any questions. Once the address information is updated and the revalidation notification letter is re-sent, the provider will still have 30 days from the date on the original revalidation notification letter to fully complete the provider revalidation process. If your clinic’s address information has not changed recently or has changed recently but the address change procedure was followed correctly, your revalidation notification letter will be mailed later in summer 2015. Revalidation FAQs PDF

Yes, if you want to maintain your enrollment with South Carolina Healthy Connections Medicaid. Revalidation FAQs PDF

Yes. Revalidation FAQs PDF

Within 30 days from the date on the revalidation notification letter, all other NPIs attached to your Medicaid ID will need to complete an electronic provider enrollment application. To access the online provider enrollment application, copy and paste https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/ into your browser. If you did not complete an electronic provider enrollment application for all non-primary NPIs associated with your Medicaid ID and you wish to continue billing with those NPIs, claims for those NPIs will be rejected. You may resubmit claims once you have received confirmation that the electronic provider enrollment application is complete. Revalidation FAQs PDF

No, not if you have paid your Medicare fee in the last 12 months. Revalidation FAQs PDF

The provider revalidation application allows you to list multiple organizations that you may be affiliated with or linked to. You will need to include every group you are associated with currently. You do not need to complete a provider revalidation application for each group. The group provider is responsible for provider revalidation. Revalidation FAQs PDF

No, not if you have paid your Medicare fee in the last 12 months. Revalidation FAQs PDF

Yes, if you want to maintain your enrollment with South Carolina Healthy Connections Medicaid. Revalidation FAQs PDF

Yes. Revalidation FAQs PDF

Yes. Revalidation FAQs PDF

Remove decimal points from the code. To start afresh, backspace to the beginning of the field or highlight the characters in the code and press delete.

MCCS can send a copy of the TAD when requested.

You are not required to go through this current provider revalidation process. You will be notified of the next provider revalidation process when it begins. Revalidation FAQs PDF

Yes, the website is secure. South Carolina Healthy Connections Medicaid uses the national standard in website security software to ensure that the information entered onto the site is secure. Revalidation FAQs PDF

Yes, the website is secure. South Carolina Healthy Connections Medicaid uses the national standard in website security software to ensure that the information entered onto the site is secure. Revalidation FAQs PDF

Yes, information is listed in red.

For 2015, SCDHHS must collect a $553 application fee prior to executing a provider agreement whether upon an initial enrollment, reactivation, revalidation or an enrollment to add a new practice location. [Note: $542 for 2014.] The provider enrollment application fee is applicable to providers that the Centers for Medicare & Medicaid Services (CMS) has identified as institutional providers.  South Carolina Healthy Connections Medicaid recognizes and enrolls the following institutional providers:  Ambulatory Surgery Centers, Community Mental Health Centers; Comprehensive Outpatient Rehabilitation Facilities; Durable Medical Equipment, End Stage Renal Disease Facilities; Federally Qualified Health Centers; Home Health Agencies; Hospices; Hospitals, Acute Inpatient Facilities, Inpatient Psychiatric Facilities, Inpatient Rehabilitation Facilities, Independent Clinical Laboratories; Skilled Nursing Facilities and Rural Health Clinics.

The fee is to be used to cover the cost of program integrity efforts including the cost of screening associated with provider enrollment processes. This fee can vary from year to year based on adjustments made pursuant to the Consumer Price Index for Urban Areas (CIP-U). A provider will be exempt from the fee if they have submitted and received approval for a Hardship Waiver request or they can demonstrate they are enrolled or have paid the application fee to Medicare and/or another state’s Medicaid or CHIP for the same enrollment location jurisdiction.  A different enrollment jurisdiction means “a new enrollment with an address different from a currently enrolled location.”  Individual physicians (sole proprietors enrolling with an EIN and Social Security Number (SSN) are considered individuals), non-physician practitioners and non-physician practitioner organizations are exempted from paying the enrollment application fee.

Yes. Once an entry is deleted, it is lost. You can choose to make the entry inactive, so you won’t see it.

Have you recently changed your mailing address? Was the proper procedure followed to inform SCDHHS of the change? To update your address, please fax or mail a letter requesting an address change to MCCS Provider Enrollment on company letterhead. The Provider Enrollment fax number is (803) 870-9022. The address is Medicaid Provider Enrollment, P.O. Box 8809, Columbia, SC 29202-8809. The letter should include the provider’s legacy and NPI numbers, as well as the new address, along with the provider’s or an authorized person’s signature and a contact person’s name and telephone number in case there are any questions. Once the address information is updated and the revalidation notification letter is remailed, the provider will still have 30 days from the date on the original revalidation notification letter to fully complete the provider revalidation process.

If you have not recently changed your mailing address, please remember that South Carolina Healthy Connections Medicaid provider revalidation will occur in phases beginning in June 2015 and ending in March 2016. Providers should not take any steps to revalidate until they receive their revalidation notification letters. If you have not received a revalidation notification letter and your contact information is current with SCDHHS that is a strong indication that your provider revalidation phase has not begun.

Revalidation FAQs PDF

Yes, you would have to submit two different claims. You can go to your submitted claim bucket and copy the claim with additional edits and changes and then resubmit it instead of rekeying two claims.

No

No. The only way to access your revalidation reference number is to have your revalidation notification letter remailed to you. Revalidation FAQs PDF

Provider Service Center/EDI

You would need to file to Medicaid for reporting purposes and for seeing the claim through from beginning to end. 

Web Tool is updated nightly; you should always check and if they are out of visits, let them know before providing services.

Yes, there is a button to do that.

Yes and no; there are basic required fields that are denoted by asterisks, however if you forget modifiers, the Web Tool won’t recognize that.

Yes

No, you just need the primary code.

Yes, you still file to the other carrier to obtain a valid denial. Three denials should be kept on file each year.

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.

They purge based on the check date.

Yes, only paid claims can receive an overpayment or underpayment.

No signature is required for terminations.

In South Carolina, no, provider revalidation is not the same thing as recertification. However, some states use terms such as “revalidating,” “recertifying” or “recredentialing” interchangeably.  South Carolina Healthy Connections Medicaid provider revalidation could possibly be different from other states’ recertification process and certification updates required for specific provider types. For example, a certified nurse practitioner who is also a Medicaid provider needs to ensure that they have completed the provider revalidation process with South Carolina Healthy Connections Medicaid and that they have been recertified by the American Academy of Nurse Practitioners. The two processes are separate. Revalidation FAQs PDF

The Medicaid Credit Balance Report is not replacing the current credit balance reviews performed by other reviewing agencies. Providers are not to report other agencies’ identified claims on the Medicaid Credit Balance Report - this may cause possible duplication of claim recoupment. Providers impacted by such reviews need to continue their current procedure in responding to any correspondence received from other agencies’ credit balance reviews.

Nursing Facilities and ICFs/MR are not reimbursed for the date of discharge.

Nursing Facilities and ICFs/MR should not invoice hospice agencies for the date of discharge. The date of hospice discharge for a reason other than death or transfer to another facility is billed to Medicaid.

For example: If the person was in an NF or ICF/MR facility from Feb. 1 to Feb. 23, 2013, and was enrolled in hospice from Feb. 1 to Feb. 14, 2013, the hospice would pay NF or ICF/MR the room and board for Feb. 1 to Feb. 13, 2013. Medicaid would pay the NF or ICF/MR for dates of service from Feb. 14 to Feb. 22, 2013. 

No, they have their own forms and billing systems.

Yes.

Yes, the Web Tool is updated every night.

There is not a limit to the number of claims in a batch.

No; you can only view that claim’s status.

The provider revalidation process for South Carolina Healthy Connections Medicaid providers and South Carolina Healthy Connections Medicaid DME suppliers is the same. The timeline is different. DME suppliers need to revalidate every three years. Revalidation FAQs PDF

If MMIS validates the NPI of the rendering physician, then the claim will deny if the individual has not revalidated. Revalidation FAQs PDF

Yes. Once corrections are made, Medicaid claims should be re-billed using the CRCF-01 form for OSS and the DHHS 181 for NFs. Coinsurance claims can be submitted at any time of the month once corrections are made.

Is that the last day that I can submit my provider revalidation application? Is that the day I will receive provider revalidation confirmation from South Carolina Healthy Connections Medicaid?

South Carolina Healthy Connections Medicaid mailed revalidation notification letters for phase 1 of provider revalidation on June 4^th, 2015. South Carolina Healthy Connections Medicaid provider revalidation will occur in phases from June 2015 to March 2016. When it is time to revalidate your enrollment as a South Carolina Healthy Connections Medicaid provider, you will receive a revalidation notification letter in the mail. Revalidation FAQs PDF

The provider revalidation notification letter will be mailed to the primary practice location address. Revalidation FAQs PDF

Yes, it doesn’t matter the submission method.

• Enhanced provider screening and enrollment based on risk categories (limited, moderate and high) for fraud, waste and abuse for each provider type as assigned by CMS and the SCDHHS.
• Background checks and unannounced pre and post enrollment site visits.  Fingerprint-based criminal history records checks.   At the present time, the criminal background checks and fingerprinting are not required. 
• Updated Disclosure of Ownership and Controlling Interest Statements
• Enrollment of ordering/referring providers 
• Suspension of provider Medicaid payments in cases of credible allegations of fraud
• Denial of enrollment and/or termination of a provider from the Medicaid program “for cause”.  This is defined as the revocation of Medicaid billing privileges for specific reasons such as denial/termination from the Medicare program, denial/termination from other state Medicaid and Children’s Health Insurance Programs, or other reasons based on credible allegations of fraud, integrity or quality.
• Institution of application enrollment fees for business organizations and entities that are enrolling with South Carolina Medicaid with an Employee Identification Number (EIN).
• Implementation of a temporary moratorium on new provider enrollments, when instructed by CMS, to protect against high risk of fraud and abuse. 
• Revalidation of enrolled providers at least every five years, with the exception of DME providers, who need to revalidate every three years.

You will receive a site visit form with this information after your site visit has been scheduled. Revalidation FAQs PDF

It is highly recommended that you make sure your primary practice location address and provider type are current with South Carolina Healthy Connections Medicaid. It is your responsibility to ensure that your information is current.

To update your address, please fax or mail a letter requesting an address change to MCCS Provider Enrollment on company letterhead. The Provider Enrollment fax number is (803) 870-9022. The address is Medicaid Provider Enrollment, P.O. Box 8809, Columbia, SC 29202-8809. The letter should include the provider’s legacy and NPI numbers, as well as the new address, along with the provider’s or an authorized person’s signature and a contact person’s name and telephone number in case there are any questions. To update info other than an address, please go to www.scdhhs.gov/Provider and select “FAQ Guide” for instructions on how to update information in your profile.

Revalidation FAQs PDF

The trading partner agreement form needs to be completed.

No changes will be made regarding beneficiaries’ income, IPC/CRCF status, etc., for the current billing month if change forms are not received by MCCS. However, changes can be made during the next month’s billing process.

The hospice is responsible for the room and board amount.

It is imperative that the hospice social worker continues to pursue eligibility for the resident to decrease the financial risk in the event the resident is ultimately not eligible for nursing facility benefits. 

*Nursing Facility (NF) or Intermediate Care Facility (ICF) / Mental Retardation (MR)

The nursing facility must submit a request for an adjustment. The adjustment process must be completed before the hospice can be paid for room and board dates of service.

If a beneficiary no longer has the insurance policy that is seen on the Web Tool, the provider can refer the beneficiary to their eligibility counselor/worker, or complete the Health Insurance Information Referral Form (HIIRF) to update the beneficiary’s third party payer information. Making a change to a policy that already exists in the Medicaid Management Information System (MMIS) takes five days. The HIIRF Form can be faxed to 803-252-0870.

If you do not fully complete the provider revalidation process within 30 days from the date on the notification letter, it is considered voluntary termination from South Carolina Healthy Connections Medicaid. You will need to enroll as a new provider. Revalidation FAQs PDF

If any information that you used for your provider enrollment has changed and you have not informed SCDHHS of the change, you will need to follow the standard procedure to update your information. Please go to www.scdhhs.gov/Provider and select “FAQ Guide” for instructions on how to update information in your profile. Revalidation FAQs PDF

If the revalidation notification letter is returned to South Carolina Healthy Connections Medicaid as undeliverable mail, we will call you using the phone number on file in order to update your address. You will need to follow the standard procedure to update your address. To update your address, please fax or mail a letter requesting an address change to MCCS Provider Enrollment on company letterhead. The Provider Enrollment fax number is (803) 870-9022. The address is Medicaid Provider Enrollment, P.O. Box 8809, Columbia, SC 29202-8809. The letter should include the provider’s legacy and NPI numbers, as well as the new address, along with the provider’s or an authorized person’s signature and a contact person’s name and telephone number in case there are any questions. Once the address information is updated and the revalidation notification letter is re-sent, the provider will still have 30 days from the date on the original revalidation notification letter to fully complete the provider revalidation process.

If you are unable to be reached using the phone number on file, your inability to complete the provider revalidation process means that you have voluntarily terminated as a South Carolina Healthy Connections Medicaid provider and will need to enroll as a new provider.

Revalidation FAQs PDF

If your revalidation reference number does not work on the website, ensure that the computer you are using meets the web application system requirements for the provider revalidation application. Please visit https://www.scdhhs.gov/ProviderRequirements and scroll to the section labeled “Web Application System Requirements” for more information.

If you are still unable to use your revalidation reference number, please contact the Provider Service Center at (888) 289-0709, option 4.

Revalidation FAQs PDF

If there are NPIs associated with your Medicaid ID that you do not want to revalidate, do not complete an enrollment application for them. No action is needed on your part. Revalidation FAQs PDF

A checklist of the documentation that you will need for the provider revalidation process can be found by copying and pasting this link you’re your browser https://www.scdhhs.gov/sites/default/files/Online%20Enrollment%20Application%20Visual%20Guide.pdf or by visiting https://www.scdhhs.gov/Provider and selecting “Online Application Visual Guide” from the “Provider Enrollment Information” section. This is currently a link to the Provider Online Enrollment Application Visual Guide. The information needed for enrollment is very similar to the information needed for revalidation. Revalidation FAQs PDF

A credit balance is a positive amount that remains in a patient’s account which may have resulted from multiple reimbursements from several payers, adjustments to previously paid claims of a provider, duplicate payment, or subrogation events due to accidents and other injury cases. When another third party payer reimburses a provider for claims that Medicaid paid, either in part or in full, a refund is due to the Medicaid Program.

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.

If your service requires a referral, the MHN gives you an authorization number.

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

The payment cycle is: Wed-Mon, payments are processed on Tuesday, and payment is received as early as Friday.

The PO boxes and physical address are included in the Provider manual as well as on the mailing envelope.

NOTE: Late change forms should be sent overnight or faxed, with all attachments, to (803) 870-9020. Forms should not be faxed unless they are sent past the deadline. Faxed corrections should be received no later than the third working day of each month for Nursing Home providers and the 17th day of the month for OSS providers.

The Non-Contractual box is to be selected/entered when the provider is not contracted with the beneficiary’s third party payer.

You must wait for the rejection, and then do a correction. An adjustment can only be made to a paid claim.

TADs are not yet available on the Web Tool. Medicaid will continue to send copies of the TADs to providers until the TADs are available on the Web Tool.

Nursing Home change forms are due to MCCS on the first working day of each month. OSS change forms are due no later than the 17th of each month. These dates are subject to change based on holidays, etc.

South Carolina Healthy Connections Medicaid mailed revalidation notification letters for phase 1 of provider revalidation on June 4^th, 2015. Providers should not take any steps to revalidate until they receive their revalidation notification letters. It is important that providers keep their address information up to date to ensure that they receive the revalidation notification letter.

South Carolina Healthy Connections Medicaid provider revalidation will occur in phases beginning in June 2015 and ending in March 2016. Providers should not take any steps to revalidate until they receive their revalidation notification letters. It is important that providers keep their address information up to date to ensure that they receive the revalidation notification letter.

Revalidation FAQs PDF

The system recognizes when your password does not meet the password requirements.  However, if you have reviewed your selected password and it does meet the password requirements, contact the EDI Support Center at 1-888-289-0709, and choose Option “1”. 

Reports are due by the 30th day of the following month after the respective quarter end. If the report has not been submitted by the due date, a late notification letter will be sent to the provider.

You should check before providing services.

Once the provider revalidation process is complete and error free, provider revalidation approval will be emailed to the email address entered during the provider revalidation process within 30 days. Revalidation FAQs PDF

Although indicated in a May 9, 2012 Medicaid Bulletin and letter to State Agencies this would be implemented by August 1, 2012, due to delays a new implementation date will be targeted and communicated to providers in future bulletins. Prior to implementation, provider outreach activities will focus on communication of the new policies and other related information. New screening and enrollment information will be distributed through Medicaid bulletins, SCDHHS website messages and alerts, training and orientation activities for certain programs and updates to Program Manuals.

You would use a void if you bill for something by mistake; accidental claim submission, for example.

Appendix 2 of your SCDHHS Provider Manual.

On the Claim Entry screen, go to the Document tab to attach your documentation. (Effective August 17, 2015) Claims Attachments – Web Tool Reference Guide.

For additional information about the South Carolina Healthy Connections Medicaid provider revalidation process, please visit www.scdhhs.gov/revalidation or medicaidelearning.remote-learner.net. Revalidation FAQs PDF

The Medicaid Credit Balance Report Certification Page and Claim Detail forms can be found under the For Providers menu option at SCDHHS.gov – see Credit Balance Forms.

That form can be found on SCDHHS.gov.

During the online enrollment process, organizations cannot affiliate individuals to their group. It is the responsibility of the individual provider to affiliate with a group. The request must be on the business letterhead to include the Group’s Medicaid Legacy ID number and the provider’s NPI number 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.

The reports and checks may be mailed regular or certified mail to MIVS, Attn: Benefit Recovery – Credit Balance Reporting, P.O. Box 8355, Columbia, SC 29202-8355 or may be sent by facsimile to MIVS, Attn: Benefit Recovery – Credit Balance Reporting, 803-462-2582.

The Centers for Medicare and Medicaid Services (CMS), under standards established by the Affordable Care Act (ACA), with a focus on strengthening requirements for Medicaid provider screening and other enrollment requirements. 

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

The hospice agency is responsible for pharmaceutical costs related to pain management and symptom control of the terminal illness.

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. 

Contact the PSC, option “2” for claims issues. 

SCDHHS requires updates to a provider’s file to be submitted in writing on business letterhead with the provider’s or an authorized signature. Submit any updated changes 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.

A provider is notified about rejections via the Enrollment Rejection Letter. The rejection letter indicates the reason(s) for the rejection. For further assistance, contact the Provider Service Center at 1 (888) 289-0709, option 4.

When an Individual provider is affiliated with a group, the original group enrollment date remains the same regardless of when the individual provider was affiliated. The individual provider does not receive a new enrollment date when affiliated with the group.

Providers that submit inaccurate or incomplete information will be notified of the rejected credit balance report. The provider will be instructed to re-submit another report for the applicable quarter.

A 951 Edit Code means the beneficiary was not eligible for Medicaid on the date of service. The beneficiary and/or responsible party for the beneficiary might not have completed the annual Medicaid eligibility review. Inform the nursing facility caller to contact the beneficiary’s eligibility caseworker.                                                                                                                                                                                

Yes, a provider will be notified via certified mail when terminated for cause. The provider does have appeal rights.

No.

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

A provider can verify Managed Care Organization enrollment on the eligibility section of the Web Tool under the “Beneficiary Special Program Data” section.

Upon approval of enrollment (the provider has met all necessary requirements); the enrollment date of the provider’s effective date will retroactively begin 90 days prior to the date of receipt of the application. However, depending on the provider’s type/ specialty, if the provider is required to sign a contractual agreement in addition to the provider enrollment agreement, the enrollment date is the effective date of the contract. Note: Medicaid will not pay for claims prior to an enrollment effective date or before the provider’s licensure/certification date.

No, because it did not process. 

CMS will continuously evaluate whether they need to change the assignment of categories of providers and suppliers to various risk categories.  If they assign certain groups of providers and/or suppliers to a different category, this change will be proposed in the Federal Register.

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.

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

Yes

No, it is not tied to another system. Updates are your responsibility.

No, there is no limit on password attempts.