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 member’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.