Learning Resources
Frequently Asked Questions
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Do all providers need to go through the provider revalidation process?All South Carolina Healthy Connections Medicaid providers will go through the provider revalidation process. The current process, however, is for all South Carolina Healthy Connections Medicaid providers who have an enrollment date 90 days prior to or on 12/03/2012. These providers are required to go through the provider revalidation process. Revalidation FAQs PDF | |
Do all providers need to pay the provider revalidation application fee?If you are an institutional provider as determined by CMS, you will need to pay a provider revalidation fee of $553.00 if you revalidate in 2015. The 2016 fee will be determined by CMS and will be published after it is established by CMS. If you are a provider with multiple NPIs associated with your Medicaid ID, you will need to complete a new enrollment for each non-primary NPI. You are responsible for the new enrollment fee/s. Revalidation FAQs PDF | |
Do I have to request another Login and Password if more than one person wants to use the Web Tool?Yes, all users must have their own individual login ID and Password to access the Web Tool. If more than one user tries to login under the same login ID and Password, they will receive a denial message. | |
Do I need to contact South Carolina Healthy Connections Medicaid to schedule a site visit?No. If a site visit is needed, a Provider Relations Representative will contact you. Revalidation FAQs PDF | |
Do I need to pay a provider revalidation application fee?If you are an institutional provider as determined by CMS, you will need to pay a provider revalidation fee of $553.00 if you revalidate in 2015. The 2016 fee will be determined by CMS and will be published after it is established by CMS. If you are a provider with multiple NPIs associated with your Medicaid ID, you will need to complete a new enrollment for each non-primary NPI. You are responsible for the new enrollment fees. Revalidation FAQs PDF | |
Do I still submit the UB-04 adjustment if I've submitted the credit balance report? | |
Do other states have provider revalidation?Yes, all 50 states have been mandated to perform provider revalidation. Revalidation FAQs PDF | |
Do we need to send an EOB?An Explanation of Benefits from a third party payer should be kept on file in the provider’s office, especially if the payer didn’t submit payment. | |
Do we send an EOB with claims?You do not send an EOB with claims, unless it is requested. | |
Do you file to another payer when you know services are not covered?Yes, this is considered a valid denial. | |
Do you have to ask MIVS to research TPL non-payment?No, they do this on their own to ensure payment. | |
Do you have to put in diagnosis codes?If the service you are providing requires the use of a diagnosis code, then you must enter the diagnosis code with your claim information. | |
Do you have to put the last 4 digits of the zip code for Claims Entry?Yes; you can find zip codes on the US Postal Services website: www.usps.com. Click on Look Up a Zip Code™ | |
Do you have to submit claims through Web Tool?No, you may use other options like hard copy or vendor/clearing house. | |
Does a beneficiary have to be on Medicaid to qualify for HIPP?No, but they must be Medicaid eligible. | |
Does Suspended mean processing?No; Suspended means that the claim is in review. | |
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 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?Yes | |