Frequently Asked Questions

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In the Web Tool's status section, do claims purge based on batch ID?

They purge based on the check date.

Is an adjustment only done when you have been paid?

Yes, only paid claims can receive an overpayment or underpayment.

Is an eligibility signature required for termination? (Nursing Home)

No signature is required for terminations.

Is revalidating as a provider the same thing as recertifying or updating my provider credentials?

In South Carolina, no, provider revalidation is not the same thing as recertification. However, some states use terms such as “revalidating,” “recertifying” or “recredentialing” interchangeably. South Carolina Healthy Connections Medicaid provider revalidation could possibly be different from other states’ recertification process and certification updates required for specific provider types. For example, a certified nurse practitioner who is also a Medicaid provider needs to ensure that they have completed the provider revalidation process with South Carolina Healthy Connections Medicaid and that they have been recertified by the American Academy of Nurse Practitioners. The two processes are separate. Revalidation FAQs PDF

Is the credit balance report replacing other credit balance reivews I receive from other agencies?

The Medicaid Credit Balance Report is not replacing the current credit balance reviews performed by other reviewing agencies. Providers are not to report other agencies’ identified claims on the Medicaid Credit Balance Report - this may cause possible duplication of claim recoupment. Providers impacted by such reviews need to continue their current procedure in responding to any correspondence received from other agencies’ credit balance reviews.

Is the date of discharge for Nursing Facilities or Intermediate Care Facility (ICF) / Mental Retardation (MR) room and board Medicaid reimbursable?

Nursing Facilities and ICFs/MR are not reimbursed for the date of discharge.

Nursing Facilities and ICFs/MR should not invoice hospice agencies for the date of discharge. The date of hospice discharge for a reason other than death or transfer to another facility is billed to Medicaid.

For example: If the person was in an NF or ICF/MR facility from Feb. 1 to Feb. 23, 2013, and was enrolled in hospice from Feb. 1 to Feb. 14, 2013, the hospice would pay NF or ICF/MR the room and board for Feb. 1 to Feb. 13, 2013. Medicaid would pay the NF or ICF/MR for dates of service from Feb. 14 to Feb. 22, 2013.

Is the EFT form used for MCOs as well?

No, they have their own forms and billing systems.

Is the Web Tool claim ID number automatically entered?

Yes.

Is the Web Tool updated daily?

Yes, the Web Tool is updated every night.

Is there a limit to the number of claims in a Web Tool batch?

There is not a limit to the number of claims in a batch.

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