Your revalidation notification letter will list all of the NPIs associated with your Medicaid ID. The revalidation notification letter will identify one NPI as being the primary NPI associated with your Medicaid ID.  Complete the provider revalidation application for the primary NPI following the standard procedure. Within 30 days from the date on the revalidation notification letter, all other NPIs attached to your Medicaid ID will need to complete an online provider enrollment application. To access the online provider enrollment application, copy and paste https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/ into your browser. This ensures that the billing process continues uninterrupted. Revalidation FAQs PDF

All medical clinics will revalidate within June, July or August 2015. If your clinic’s address information has changed recently and needs to be updated, 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. If your clinic’s address information has not changed recently or has changed recently but the address change procedure was followed correctly, your revalidation notification letter will be mailed later in summer 2015. Revalidation FAQs PDF

Yes, if you want to maintain your enrollment with South Carolina Healthy Connections Medicaid. Revalidation FAQs PDF

Yes. Revalidation FAQs PDF

Within 30 days from the date on the revalidation notification letter, all other NPIs attached to your Medicaid ID will need to complete an electronic provider enrollment application. To access the online provider enrollment application, copy and paste https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/ into your browser. If you did not complete an electronic provider enrollment application for all non-primary NPIs associated with your Medicaid ID and you wish to continue billing with those NPIs, claims for those NPIs will be rejected. You may resubmit claims once you have received confirmation that the electronic provider enrollment application is complete. Revalidation FAQs PDF

No, not if you have paid your Medicare fee in the last 12 months. Revalidation FAQs PDF

The provider revalidation application allows you to list multiple organizations that you may be affiliated with or linked to. You will need to include every group you are associated with currently. You do not need to complete a provider revalidation application for each group. The group provider is responsible for provider revalidation. Revalidation FAQs PDF

No, not if you have paid your Medicare fee in the last 12 months. Revalidation FAQs PDF

Yes, if you want to maintain your enrollment with South Carolina Healthy Connections Medicaid. Revalidation FAQs PDF

Yes. Revalidation FAQs PDF

Yes. Revalidation FAQs PDF

Remove decimal points from the code. To start afresh, backspace to the beginning of the field or highlight the characters in the code and press delete.

MCCS can send a copy of the TAD when requested.

You are not required to go through this current provider revalidation process. You will be notified of the next provider revalidation process when it begins. Revalidation FAQs PDF

Yes, the website is secure. South Carolina Healthy Connections Medicaid uses the national standard in website security software to ensure that the information entered onto the site is secure. Revalidation FAQs PDF

Yes, the website is secure. South Carolina Healthy Connections Medicaid uses the national standard in website security software to ensure that the information entered onto the site is secure. Revalidation FAQs PDF

Yes, information is listed in red.

For 2015, SCDHHS must collect a $553 application fee prior to executing a provider agreement whether upon an initial enrollment, reactivation, revalidation or an enrollment to add a new practice location. [Note: $542 for 2014.] The provider enrollment application fee is applicable to providers that the Centers for Medicare & Medicaid Services (CMS) has identified as institutional providers.  South Carolina Healthy Connections Medicaid recognizes and enrolls the following institutional providers:  Ambulatory Surgery Centers, Community Mental Health Centers; Comprehensive Outpatient Rehabilitation Facilities; Durable Medical Equipment, End Stage Renal Disease Facilities; Federally Qualified Health Centers; Home Health Agencies; Hospices; Hospitals, Acute Inpatient Facilities, Inpatient Psychiatric Facilities, Inpatient Rehabilitation Facilities, Independent Clinical Laboratories; Skilled Nursing Facilities and Rural Health Clinics.

The fee is to be used to cover the cost of program integrity efforts including the cost of screening associated with provider enrollment processes. This fee can vary from year to year based on adjustments made pursuant to the Consumer Price Index for Urban Areas (CIP-U). A provider will be exempt from the fee if they have submitted and received approval for a Hardship Waiver request or they can demonstrate they are enrolled or have paid the application fee to Medicare and/or another state’s Medicaid or CHIP for the same enrollment location jurisdiction.  A different enrollment jurisdiction means “a new enrollment with an address different from a currently enrolled location.”  Individual physicians (sole proprietors enrolling with an EIN and Social Security Number (SSN) are considered individuals), non-physician practitioners and non-physician practitioner organizations are exempted from paying the enrollment application fee.

Yes. Once an entry is deleted, it is lost. You can choose to make the entry inactive, so you won’t see it.

Have you recently changed your mailing address? Was the proper procedure followed to inform SCDHHS of the change? 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 remailed, the provider will still have 30 days from the date on the original revalidation notification letter to fully complete the provider revalidation process.

If you have not recently changed your mailing address, please remember that South Carolina Healthy Connections Medicaid provider revalidation will occur in phases beginning in June 2015 and ending in March 2016. Providers should not take any steps to revalidate until they receive their revalidation notification letters. If you have not received a revalidation notification letter and your contact information is current with SCDHHS that is a strong indication that your provider revalidation phase has not begun.

Revalidation FAQs PDF

Yes, you would have to submit two different claims. You can go to your submitted claim bucket and copy the claim with additional edits and changes and then resubmit it instead of rekeying two claims.

No

No. The only way to access your revalidation reference number is to have your revalidation notification letter remailed to you. Revalidation FAQs PDF

Provider Service Center/EDI

You would need to file to Medicaid for reporting purposes and for seeing the claim through from beginning to end. 

Web Tool is updated nightly; you should always check and if they are out of visits, let them know before providing services.

Yes, there is a button to do that.

Yes and no; there are basic required fields that are denoted by asterisks, however if you forget modifiers, the Web Tool won’t recognize that.

Yes

No, you just need the primary code.

Yes, you still file to the other carrier to obtain a valid denial. Three denials should be kept on file each year.

Once a claim is submitted via the Web Tool, there is no way to cancel or make a correction to the submitted claim that same day.  Once the claim has gone through the payment cycle, you will be able to see if the claim has been rejected, paid, or suspended.  You will then be able to make corrections to the claim before resubmitting as a new claim.

They purge based on the check date.

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

No signature is required for terminations.

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

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.

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. 

No, they have their own forms and billing systems.

Yes.

Yes, the Web Tool is updated every night.

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

No; you can only view that claim’s status.

The provider revalidation process for South Carolina Healthy Connections Medicaid providers and South Carolina Healthy Connections Medicaid DME suppliers is the same. The timeline is different. DME suppliers need to revalidate every three years. Revalidation FAQs PDF