Learning Resources
Frequently Asked Questions
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Where can I attach documentation to my Web Tool claim?On the Claim Entry screen, go to the Document tab to attach your documentation. (Effective August 17, 2015) Claims Attachments – Web Tool Reference Guide. | |
Who is mandating the provider revalidation process?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 | |
What is provider revalidation?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 | |
Do other states have provider revalidation?Yes, all 50 states have been mandated to perform provider revalidation. Revalidation FAQs PDF | |
Is this the same thing as the Durable Medical Equipment (DME) revalidation process?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 | |
Is revalidating as a provider the same thing as recertifying or updating my provider credentials?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 | |
Do all providers need to go through the provider revalidation process?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 | |
I enrolled after 12/03/2012. Am I required to go through the provider revalidation process?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 | |
I am a Medicare provider who has revalidated with Medicare. Do I need to revalidate with South Carolina Healthy Connections Medicaid?Yes, if you want to maintain your enrollment with South Carolina Healthy Connections Medicaid. Revalidation FAQs PDF | |
I am an out of state South Carolina Healthy Connections Medicaid provider, and I have already revalidated with my state. Do I need to revalidate with South Carolina Healthy Connections Medicaid?Yes, if you want to maintain your enrollment with South Carolina Healthy Connections Medicaid. Revalidation FAQs PDF | |