Frequently Asked Questions


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Frequently Asked Questions

 

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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 doing a void/replace adjustment, does the Form 130 go along with the CMS-1500 claim form?

Yes, the replacement claim will be attached to the Form 130.

If I delete a person from the Web Tool list and the person returns, do I have to re-enter all of the information?

Yes. Once an entry is deleted, it is lost. You can choose to make the entry inactive, so you won’t see it.


If I do not receive the revalidation notification letter, what can I do?

Have you recently changed your mailing address? Was the proper procedure followed to inform SCDHHS of the change? To update your address, please fax or mail a letter requesting an address change to MCCS Provider Enrollment on company letterhead. The Provider Enrollment fax number is (803) 870-9022. The address is Medicaid Provider Enrollment, P.O. Box 8809, Columbia, SC 29202-8809. The letter should include the provider’s legacy and NPI numbers, as well as the new address, along with the provider’s or an authorized person’s signature and a contact person’s name and telephone number in case there are any questions. Once the address information is updated and the revalidation notification letter is remailed, the provider will still have 30 days from the date on the original revalidation notification letter to fully complete the provider revalidation process.

If you have not recently changed your mailing address, please remember that South Carolina Healthy Connections Medicaid provider revalidation will occur in phases beginning in June 2015 and ending in March 2016. Providers should not take any steps to revalidate until they receive their revalidation notification letters. If you have not received a revalidation notification letter and your contact information is current with SCDHHS that is a strong indication that your provider revalidation phase has not begun.

Revalidation FAQs PDF


If I have a difficult payer, do I need to complete a reasonable effort document?

Yes you can. It is to show efforts made to obtain other payments from other insurers.

If I have two separate claims for one beneficiary, do I have to enter the claim information twice on Web Tool?

Yes, you would have to submit two different claims. You can go to your submitted claim bucket and copy the claim with additional edits and changes and then resubmit it instead of rekeying two claims.


If I send a HIIRF, will I see anything saying it was received?

No, just wait a few days and check eligibility again.

If I submit a claim through a vendor, will I be able to view it under Web Tool’s History?

No


If I think my revalidation notification letter is lost in the mail, can I call the Provider Service Center and have someone give me my revalidation reference number over the phone?

No. The only way to access your revalidation reference number is to have your revalidation notification letter remailed to you. Revalidation FAQs PDF


If my third party has several addresses, which one do I choose?

You would contact the company to find out which address is for your service area.


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