Learning Resources
Frequently Asked Questions
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Why are Web Tool claims suspending?Contact the PSC, option “2” for claims issues. | |
Why can’t we update our enrollment profile over the phone?SCDHHS requires updates to a provider’s file to be submitted in writing on business letterhead with the provider’s or an authorized signature. Submit any updated changes via Fax: (803) 870-9022 or Mail: Medicaid Provider Enrollment, PO Box 8809, Columbia, SC 29202-8809. Updates will be processed within ten (10) days of receipt. | |
Why did my enrollment application get rejected after I made the corrections I was told to?A provider is notified about rejections via the Enrollment Rejection Letter. The rejection letter indicates the reason(s) for the rejection. For further assistance, contact the Provider Service Center at 1 (888) 289-0709, option 4. | |
Why is the group enrollment effective date before the date our individual provider joined the group?When an Individual provider is affiliated with a group, the original group enrollment date remains the same regardless of when the individual provider was affiliated. The individual provider does not receive a new enrollment date when affiliated with the group. | |
Why was my credit balance report rejected?Providers that submit inaccurate or incomplete information will be notified of the rejected credit balance report. The provider will be instructed to re-submit another report for the applicable quarter. | |
Why would a Nursing Facility provider receive a 951 rejection if the beneficiary had always been eligible for NF Medicaid since entering the facility?A 951 Edit Code means the beneficiary was not eligible for Medicaid on the date of service. The beneficiary and/or responsible party for the beneficiary might not have completed the annual Medicaid eligibility review. Inform the nursing facility caller to contact the beneficiary’s eligibility caseworker. | |
Will a provider be notified if they are terminated “for cause” and do they have appeal rights?Yes, a provider will be notified via certified mail when terminated for cause. The provider does have appeal rights. | |
Will every Nursing Facility or Intermediate Care Facility (ICF) / Mental Retardation (MR) have the same rate?No. | |
Will I need a site visit?All moderate and high risk providers will need a site visit. The site visit must occur within 30 days from the date on the revalidation notification letter. Revalidation FAQs PDF | |