Frequently Asked Questions
Frequently Asked Questions
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For HIPP referral, who should you contact?
How are MCO plans chosen for a beneficiary if they are auto-enrolled?
The plan is chosen based on the beneficiary’s needs, service area, and any needed specialists.
How are providers categorized by risk categories?
Three levels of screening (limited, moderate and high) are recognized for those provider types that are also recognized provider or supplier types under Medicare. For those provider types that are not recognized under Medicare, SCDHHS has assessed the risk of fraud, waste and abuse using similar criteria to those used in Medicare. See the list below for SCDHHS risk categories:
(State-regulated and State-licensed would generally be categorized as limited risk)
(Highly dependent on Medicare, Medicaid and CHIP to pay salaries and other operating expenses and which are not subject to additional governmental or professional oversight and would be considered moderate risk)
(Identified by the State as being especially vulnerable to improper payments and would be considered as high risk)
How are split claims broken up?
A 10 in your CCN represents 8 lines; 20 is the next 8 lines, etc.
How can a provider check to see if the ordering/referring physician is enrolled with Medicaid?
On the SCDHHS website SCDHHS.gov, there is a searchable listing of Enrolled Providers under the For Providers tab. If the provider is not listed, then the provider is not currently enrolled with Medicaid. You may also contact the Provider Service Center at 1 (888) 289-0709, option 4 to verify the provider’s enrollment.
How can I attach supporting documentation to the provider revalidation application?
There is no need to upload documentation. The provider will enter the required information and complete an attestation form verifying that all of the information is correct. Revalidation FAQs PDF
How can I find my enrollment date?
You can find your enrollment date by calling the Provider Service Center at (888) 289-0709, option 4. Revalidation FAQs PDF
How can I find my provider type?
Visit the Provider Type/ Specialty listing document found here, go to www.scdhhs.gov/provider and select the link titled “Provider Type and Specialty Listing” in the Provider Lists subsection, or please visit this link to view all provider manuals. Look in the “Billing Procedures” section of the manual or manuals that you think apply to your provider type to determine which procedures you bill for. This information will help you find your provider type. Revalidation FAQs PDF
How can I obtain more information regarding the new provider screening and other enrollment requirements?
How can I pay my fee?