Frequently Asked Questions


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Frequently Asked Questions

 

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What happens if the Nursing Facility (NF) or Intermediate Care Facility (ICF) / Mental Retardation (MR) is paid in error for hospice dates of service?

The nursing facility must submit a request for an adjustment. The adjustment process must be completed before the hospice can be paid for room and board dates of service.


What happens if you void the wrong claim?

If it is voided, you can submit a new claim in.

What happens when Medicaid recoups for retro-health recovery and it is outside of the timely filing window?

Professional billers do not receive retro health letters. Medicaid contacts or solicits billing payments from the private health plan.

What if a claim is created, but the member says that he/she no longer has the insurance on file?

If a member no longer has the insurance policy that is seen on the Web Tool, the provider can refer the member to their eligibility counselor/worker, or complete the Health Insurance Information Referral Form (HIIRF) to update the member’s third party payer information. Making a change to a policy that already exists in the Medicaid Management Information System (MMIS) takes five days. The HIIRF Form can be faxed to 803-252-0870.


What if I do not complete my provider revalidation within 30 days?

If you do not fully complete the provider revalidation process within 30 days from the date on the notification letter, it is considered voluntary termination from South Carolina Healthy Connections Medicaid. You will need to enroll as a new provider. Revalidation FAQs PDF


What if my address is correct, but other information needs to be updated?

If any information that you used for your provider enrollment has changed and you have not informed SCDHHS of the change, you will need to follow the standard procedure to update your information. Please go to www.scdhhs.gov/Provider and select “FAQ Guide” for instructions on how to update information in your profile. Revalidation FAQs PDF


What if my revalidation notification letter is returned due to an incorrect address?

If the revalidation notification letter is returned to South Carolina Healthy Connections Medicaid as undeliverable mail, we will call you using the phone number on file in order to update your address. You will need to follow the standard procedure to update your address. 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.

If you are unable to be reached using the phone number on file, your inability to complete the provider revalidation process means that you have voluntarily terminated as a South Carolina Healthy Connections Medicaid provider and will need to enroll as a new provider.

Revalidation FAQs PDF


What if my revalidation reference number does not work on the website?

If your revalidation reference number does not work on the website, ensure that the computer you are using meets the web application system requirements for the provider revalidation application. Please visit https://www.scdhhs.gov/ProviderRequirements and scroll to the section labeled “Web Application System Requirements” for more information.

If you are still unable to use your revalidation reference number, please contact the Provider Service Center at (888) 289-0709, option 4.

Revalidation FAQs PDF


What if there are NPIs associated with my Medicaid ID that I do not want to revalidate?

If there are NPIs associated with your Medicaid ID that you do not want to revalidate, do not complete an enrollment application for them. No action is needed on your part. Revalidation FAQs PDF


What if you know any other office has a claim waiting to be filed that uses the same visit counts you will be using to file a claim for a member?

You should also file right away. Area representatives can approve a few extra visits, but not every time.


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