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)

On the SCDHHS website SCDHHS.gov, 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. 

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

You can find your enrollment date by calling the Provider Service Center at (888) 289-0709, option 4. Revalidation FAQs PDF

Visit the Provider Type/ Specialty listing document found here, go to www.scdhhs.gov/provider 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

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

The fee can only be paid at https://ssl.sc.gov/Checkout/DHHS. The fee will be collected prior to the provider revalidation process. Revalidation FAQs PDF

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.

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

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

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 https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/ into your browser. Revalidation FAQs PDF

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

Individuals can be added anytime to a group without having to pay an application fee. If an individual wants to be added to a group that is not currently enrolled, the group will have to pay an application fee and enroll. Once the group is enrolled, the individual must then request to be added to the group. If the individual provider is already enrolled in South Carolina Medicaid, submit in writing an update request to have the provider affiliated with the group. The request must be on the business letterhead to include the Group’s Medicaid Legacy ID number and the provider’s NPI number with the provider’s or an authorized signature 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.   If the individual provider is currently in the process of enrolling, the provider can indicate on the online application group affiliation.

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).

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

Providers may send an e-mail request for Medicaid credit balance receipt confirmation to creditbalancemivs@bcbssc.com.

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

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

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

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.

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

Within 12 months

15 - 18 months

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

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.

Three months.

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

After payments 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

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