Frequently Asked Questions

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Frequently Asked Questions


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Is there a limit to the number of claims in a Web Tool batch?

There is not a limit to the number of claims in a batch.

Is there a way to find a claim in History if you had not submitted it through the Web Tool?

No; you can only view that claim’s status.

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


On a hospital claim, if the pay-to provider has revalidated, but the line provider fails to revalidate, will the claim deny?

If MMIS validates the NPI of the rendering physician, then the claim will deny if the individual has not revalidated. Revalidation FAQs PDF


Should claims returned on Form 017 or 017CI without processing be re-filed?

Yes. Once corrections are made, Medicaid claims should be re-billed using the CRCF-01 form for OSS and the DHHS 181 for NFs. Coinsurance claims can be submitted at any time of the month once corrections are made.


The bulletin references March 2016 as being the due date/last day for provider revalidation.

Is that the last day that I can submit my provider revalidation application? Is that the day I will receive provider revalidation confirmation from South Carolina Healthy Connections Medicaid?

South Carolina Healthy Connections Medicaid mailed revalidation notification letters for phase 1 of provider revalidation on June 4th, 2015. South Carolina Healthy Connections Medicaid provider revalidation will occur in phases from June 2015 to March 2016. When it is time to revalidate your enrollment as a South Carolina Healthy Connections Medicaid provider, you will receive a revalidation notification letter in the mail. Revalidation FAQs PDF

To which address will the provider revalidation notification letter be mailed?

The provider revalidation notification letter will be mailed to the primary practice location address. Revalidation FAQs PDF


Under the Web Tool's status option, can I check the status of a claim I submit hard copy?

Yes, it doesn’t matter the submission method.


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.

What do I need to do to prepare for a site visit?

You will receive a site visit form with this information after your site visit has been scheduled. Revalidation FAQs PDF

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