Frequently Asked Questions

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H

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.

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