Frequently Asked Questions


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Frequently Asked Questions

 

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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.

Can I add a member to the TAD if documentation is not approved?

You must have authorized signed documentation in order to add a member to your TAD. You should not add a member before the DHHS 181 is forwarded to DHHS Medicaid Eligibility for approval. Contact your Eligibility office if additional information is needed.

What are some of the new provider screening and enrollment guidelines?

  • Enhanced provider screening and enrollment based on risk categories (limited, moderate and high) for fraud, waste and abuse for each provider type as assigned by CMS and the SCDHHS.
  • Background checks and unannounced pre and post enrollment site visits.  Fingerprint-based criminal history records checks.   At the present time, the criminal background checks and fingerprinting are not required. 
  • Updated Disclosure of Ownership and Controlling Interest Statements
  • Enrollment of ordering/referring providers 
  • Suspension of provider Medicaid payments in cases of credible allegations of fraud
  • Denial of enrollment and/or termination of a provider from the Medicaid program “for cause”.  This is defined as the revocation of Medicaid billing privileges for specific reasons such as denial/termination from the Medicare program, denial/termination from other state Medicaid and Children’s Health Insurance Programs, or other reasons based on credible allegations of fraud, integrity or quality.
  • Implementation of a temporary moratorium on new provider enrollments, when instructed by CMS, to protect against high risk of fraud and abuse
  • Revalidation of enrolled providers at least every five years, with the exception of DME providers, who need to revalidate every three years.

How do I know that my credit balance report was received?

Providers may send an e-mail request for Medicaid credit balance receipt confirmation to creditbalancemivs@bcbssc.com.

For questions call 1-888-289-0709 option 5, option 1.

If you know a service isn’t covered, do you still file to the other carrier?

Yes, you still file to the other carrier to obtain a valid denial. Three denials should be kept on file each year.

For HIPP referral, who should you contact?

For HIPP referral, providers should contact the Medicaid Insurance Verification Services at 1-888-289-0709 option 5, option 4. The HIPP Fax is 803-462-2580.

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