Learning Resources
Frequently Asked Questions
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What do you do if you contact a Primary Care Provider and they have no record of a patient?If this were to happen, you would need to contact the Managed Care Organization directly. | |
What form needs to be completed for access to the Web Tool?The trading partner agreement form needs to be completed. | |
What happens if my DHHS Form 181, CRCF 01 or IPC form is not received on time or is not received at all? | |
What happens if someone in your office initiates a refund with the 205 and an adjustment, how do you get it back?The program area would have to research the adjustment to return funds. | |
What happens if the Nursing Facility (NF) or Intermediate Care Facility (ICF) / Mental Retardation (MR) is paid in error for hospice dates of service?The nursing facility must submit a request for an adjustment. The adjustment process must be completed before the hospice can be paid for room and board dates of service. | |
What happens if you void the wrong claim?If it is voided, you can submit a new claim in. | |
What happens when Medicaid recoups for retro-health recovery and it is outside of the timely filing window?Professional billers do not receive retro health letters. Medicaid contacts or solicits billing payments from the private health plan. | |
What if a claim is created, but the beneficiary says that he/she no longer has the insurance on file?If a beneficiary no longer has the insurance policy that is seen on the Web Tool, the provider can refer the beneficiary to their eligibility counselor/worker, or complete the Health Insurance Information Referral Form (HIIRF) to update the beneficiary’s third party payer information. Making a change to a policy that already exists in the Medicaid Management Information System (MMIS) takes five days. The HIIRF Form can be faxed to 803-252-0870. | |
What if I do not complete my provider revalidation within 30 days?If you do not fully complete the provider revalidation process within 30 days from the date on the notification letter, it is considered voluntary termination from South Carolina Healthy Connections Medicaid. You will need to enroll as a new provider. Revalidation FAQs PDF | |