Frequently Asked Questions

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Frequently Asked Questions


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Does the Medicaid card have all the information needed?

No, you should further investigate eligibility using eligibility resources and the information provided on the card.

Does the Nursing Facility (NF), Intermediate Care Facility (ICF) / Mental Retardation (MR) or Swing Bed facility have to wait for a denial from DHHS before submitting an invoice to the hospice agency?

Yes. The denial must be attached.

Does the Web Tool’s Lists feature allow you to save a beneficiary’s prior authorization in a field?

No, prior authorization may not be necessary for all services. There is a field for prior authorization.

Does Web Tool’s Status show whether it is approved to be paid?



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Explain the Medicaid application fee and how much is it?

For 2015, SCDHHS must collect a $553 application fee from business organizations and entities that are enrolling in South Carolina Medicaid with an Employee Identification Number (EIN). [Note: $542 for 2014.] The fee is to be used to cover the cost of program integrity efforts including the cost of screening associated with provider enrollment processes. This fee can vary from year to year based on adjustments made pursuant to the Consumer Price Index for Urban Areas (CIP-U). The application fee will be imposed on business organizations and entities that are enrolling in South Carolina Medicaid that are: (1) initially enrolling, (2) adding a practice location and (3) revalidating enrollment information at least every five years (with the exception of DME providers, who must revalidate every three years). Providers that are EXEMPT from the application fee are: individual physicians or non-physician practitioners.


For ambulatory care, are children under 19 exempt from copay?

Children under 19 are exempt from all copays.

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