Frequently Asked Questions

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Frequently Asked Questions


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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:

Limited Risk:

(State-regulated and State-licensed would generally be categorized as limited risk)

  • Physician or non-physician practitioners and medical groups or clinics (excluding Physical Therapists and Physical Therapists Groups)
  • Nursing Homes, Hospitals, Public and Private Community Mental Health Centers, Audiologists, Certified Nurse Midwife/Licensed Midwife, Certified Registered  Nurse Anesthetists, Anesthetist Assistants, CMS Parts A & B, Managed Care Organizations,  Licensed Marriage and Family Therapists, Licensed Professional Counselors, Licensed Independent Social Workers –Clinical Practice, Psychologists, Speech Therapists, Nurse Practitioners, Physician’s Assistants, Occupational Therapists, Physicians, Speech and Hearing Clinics, End Stage Renal Disease Clinics, DHEC Clinics, Federally Qualified Health Clinics, Federally Funded Health Clinics and Rural Health Centers, Ambulatory Surgical Centers, Diabetes Education Clinics, School Districts, Developmental Rehabilitation Clinics, Infusion Centers, Pediatric Aids Clinics, Maternal and Child Health Clinics, Dentists, Opticians, Optometrists, Podiatrist, Chiropractors, Pharmacy, Pharmacy Part D, Individual Transportation Providers, Contractual Transportation Providers , Transportation Broker,  X-Ray (not portable)

Moderate 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)

  • Rehabilitative Behavioral Health Services,  Physical Therapists , Comprehensive Outpatient Rehabilitation Facilities (CORFs),  Hospice Providers, Community Long Term Care (individuals and groups), Independent Laboratories, X-Ray (portable), Ambulance and Helicopter Providers
  • Currently enrolled (revalidating Home Health Agencies)
  • Currently enrolled (revalidating DMEPOS)

 High Risk:

(Identified by the State as being especially vulnerable to improper payments and would be considered as high risk)

  • Proposed (newly enrolling) Home Health Agencies (HHAs), Suppliers of Durable Medical Equipment, Prosthetics, Orthothics and Supplies (DMEPOS)

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, 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 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?

A link to the Federal Register, Vol 76, No. 22, dated February 2, 2011, can be found on the SCDHHS website at

How can I pay my fee?

The fee can only be paid at The fee will be collected prior to the provider revalidation process. Revalidation FAQs PDF

How can I verify that my claims on the Web Tool have been submitted successfully?

If you received a batch number for the submission, then the submission reached MCCS. Go to Reports and click on the type of report that was sent (i.e.: CMS-1500, etc.). If a batch number is shown for the day and number of claims in the batch sent, the submission went through.

How can we get an enrollment status update?

Contact the Provider Service Center (PSC) (888) 289-0709, option 4 for Provider Enrollment.  Please have your Reference ID number available.

How can you find out MHN info for a beneficiary?

A provider can verify Medical Homes Network enrollment on the eligibility section of the Web Tool under the “Beneficiary Special Program Data” section.

How can you get copies of enrollment letters?

To receive a copy of a beneficiary’s enrollment letter, they may contact Healthy Connections Choices or the beneficiary’s plan (that they were enrolled into).

How do I complete the provider revalidation process for all other NPIS associated with my Medicaid ID?

You will need to complete a new enrollment for every NPI associated with your Medicaid ID except for the primary NPI that is identified on the revalidation notification letter. All new enrollments need to be completed within 30 days from the date on the revalidation notification letter. To access the online provider enrollment application, copy and paste into your browser. Revalidation FAQs PDF

How do I complete the provider revalidation process?

The provider revalidation application is available exclusively online. When it is time to revalidate your enrollment as a provider, you will receive a revalidation notification letter. You have 30 days from the date on the revalidation notification letter to complete and submit the provider revalidation application in its entirety with all current information. Revalidation FAQs PDF

How do I file a replacement claim for a paid claim that is partly incorrect?

Go to the Web Tool submission page. Log in; go to claims entry/history; click on the correct batch number; click on the correct claim number; copy; click the claim type on the left; click on batch, claim; edit; scroll down to claim submission reason code; select replacement. To complete this task, you must have the original Claim Control Number (CCN).

How do I know if I am a moderate or high risk provider?

Refer to the Provider Type/ Specialty listing document. Go to and select the link titled “Provider Type and Specialty Listing” in the Provider Lists subsection. Revalidation FAQs PDF

How do I know that my credit balance report was received?

Providers may send an e-mail request for Medicaid credit balance receipt confirmation to

For questions call 1-888-289-0709 option 5, option 1.

How do I know the charge?

You can find the charge for the service in your provider manual.

How do I make sure that my address and other information are correct?

Contact the South Carolina Healthy Connections Medicaid Provider Service Center at 888-289-0709, option 4. It is your responsibility to ensure that your contact information is current. Customer Service Advocates cannot update your address information over the phone.

To update your address, please fax or mail a letter requesting an address change to MCCS Provider Enrollment on company letterhead. The Provider Enrollment fax number is (803) 870-9022. The address is Medicaid Provider Enrollment, P.O. Box 8809, Columbia, SC 29202-8809. The letter should include the provider’s legacy and NPI numbers, as well as the new address, along with the provider’s or an authorized person’s signature and a contact person’s name and telephone number in case there are any questions. Once the address information is updated and the revalidation notification letter is re-sent, the provider will still have 30 days from the date on the original revalidation notification letter to fully complete the provider revalidation process.

Revalidation FAQs PDF

How do I update the individual provider’s name?

SCDHHS requires the individual provider to send in a completed/signed W9 form with the individual’s name, SSN, address and signature. Providers are also required to complete the Disclosure of Ownership and Control Interest Statement Form.

How do patients learn updated information?

Patients learn of updates at their enrollment anniversary dates, or you may share information with them.

How does Medicaid know what the provider is receiving from another carrier/third party payer?

There are spaces/sections on the claim form that identify what you receive from the other carrier.

How far back can you bill?

Within 12 months

How far back can you file a void?

15 - 18 months

How long do I have to complete the provider revalidation process?

You have 30 days from the date on the revalidation notification letter to complete and submit your provider revalidation application in its entirety with all current information. Revalidation FAQs PDF

How long do you have to request a hearing for an appeal?

You have 30 days to request a hearing.

How long does it take to process an adjustment?

It takes approximately 30-45 days to process an adjustment - the same as a normal claim in process.

How long does the enrollment process take?

Enrollment applications will be processed within thirty (30) business days from the date of receipt. The thirty (30) business day timeframe may be exceeded for enrollment applications that require: additional information, a site visit, a contractual agreement, or are submitted with sanction information.

How long will a Web Tool claim stay out as a draft?

Three months.

How long will it take me to complete the provider revalidation application?

Each provider type is different. Your provider type and your preparation before beginning the application will factor into the time it takes you to complete the provider revalidation application. The process will take a minimum of 30 minutes, but it may take several hours. Revalidation FAQs PDF

How often are provider manuals updated?

Provider manuals are usually updated monthly based on program area.

How soon does information show up in Web Tool’s Status?

After payments process

How will I know that I need to begin the provider revalidation process?

When it is time to revalidate your enrollment as a South Carolina Healthy Connections Medicaid provider, you will receive a revalidation notification letter in the mail. The revalidation letter will contain detailed instructions for the revalidation process and a revalidation reference number that is specific to each provider. You will use this information to access the provider revalidation application online. You will need to complete and submit the provider revalidation application in its entirety with all current information. Revalidation FAQs PDF

How will I know that my provider revalidation has been approved?

Once the provider revalidation application is approved, provider revalidation approval notification will be emailed to the email address entered on the provider revalidation application. Revalidation FAQs PDF

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