Frequently Asked Questions


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ENROLLMENT: STATUS

How long does the enrollment process take?

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.

Why did my enrollment application get rejected after I made the corrections I was told to?

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.

ENROLLMENT: UPDATE PROFILE

How do I update the individual provider’s name?

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.

Why can’t we update our enrollment profile over the phone?

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.

MANAGED CARE ORGANIZATION (MCO)

How are MCO plans chosen for a beneficiary if they are auto-enrolled?

The plan is chosen based on the beneficiary’s needs, service area, and any needed specialists.

If a plan doesn’t cover family planning, do we bill to Medicaid and send the EOB?

Certain services are “carved out”, not covered, by the MCOs and MHNs. Those services can be billed directly to SC Medicaid. You do not need to bill to the managed care plan for a denial.

If the beneficiary doesn’t have an ID number for the MCO, how do we obtain it?

Contact the MCO.

Is the EFT form used for MCOs as well?

No, they have their own forms and billing systems.

What do you do if you contact a Primary Care Provider and they have no record of a patient?

If this were to happen, you would need to contact the Managed Care Organization directly.

Will MCO info be available via the Web Tool?

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


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