Frequently Asked Questions

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Frequently Asked Questions


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When will the new screening and enrollment guidelines be implemented?

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.

Who initiated these new screening and enrollment guidelines?

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. 

Will a provider be notified if they are terminated “for cause” and do they have appeal rights?

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

Will the entities in each screening category stay the same?

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.


Can MIVS track down where other payer’s money goes if you are not paid?

No, but they can contact other payers to obtain payment information.

Can the HIIRF form be faxed?

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

Can you accept a member as just a private pay patient even if they have Medicaid?

Yes, you just have to let them know before they receive any services.

Do we need to send an EOB?

An Explanation of Benefits from a third party payer should be kept on file in the provider’s office, especially if the payer didn’t submit payment.

Do we send an EOB with claims?

You do not send an EOB with claims, unless it is requested.

Do you have to ask MIVS to research TPL non-payment?

No, they do this on their own to ensure payment.

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