Frequently Asked Questions
Frequently Asked Questions
Should claims returned on Form 017 or 017CI without processing be re-filed?
What happens if my DHHS Form 181, CRCF 01 or IPC form is not received on time or is not received at all?
What happens if the NF or ICF/MR* accepts a hospice resident while Medicaid eligibility is pending and it is later determined that the resident is not eligible? Who is responsible for room and board payment to the NF or ICF/MR?
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)
What happens if the Nursing Facility (NF) or Intermediate Care Facility (ICF) / Mental Retardation (MR) is paid in error for hospice dates of service?
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.
What is the physical address to over-night a TAD?
The PO boxes and physical address are included in the Provider manual as well as on the mailing envelope.For regular mail:Medicaid Claims Receipt – NF Claims SectionNursing HomesP.O. Box 100122Columbia, SC 29202-3122 Medicaid Claims Receipt – NF Claims SectionOSS/IPC/Hospice:P.O. Box 67Columbia, SC 29202 For UPS, FedEx, etc.Medicaid Claims Receipt – NF Claims Section or CRCF Claims Section8901 Farrow RoadColumbia, SC 29203
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.
When are TADs available for providers to view on the Web Tool?
When are the DHHS Form 181, CRCF 01 and IPC forms due back to MCCS?
Who is responsible for pharmaceutical costs as it relates to the terminal illness?
The hospice agency is responsible for pharmaceutical costs related to pain management and symptom control of the terminal illness.
Why would a Nursing Facility provider receive a 951 rejection if the beneficiary had always been eligible for NF Medicaid since entering the facility?
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.
Will every Nursing Facility or Intermediate Care Facility (ICF) / Mental Retardation (MR) have the same rate?