Frequently Asked Questions

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Frequently Asked Questions


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What information will the provider revalidation process require?

A checklist of the documentation that you will need for the provider revalidation process can be found by copying and pasting this link you’re your browser or by visiting and selecting “Online Application Visual Guide” from the “Provider Enrollment Information” section. This is currently a link to the Provider Online Enrollment Application Visual Guide. The information needed for enrollment is very similar to the information needed for revalidation. Revalidation FAQs PDF

What is a credit balance?

A credit balance is a positive amount that remains in a patient’s account which may have resulted from multiple reimbursements from several payers, adjustments to previously paid claims of a provider, duplicate payment, or subrogation events due to accidents and other injury cases. When another third party payer reimburses a provider for claims that Medicaid paid, either in part or in full, a refund is due to the Medicaid Program.

What is a Temporary Moratorium?

A temporary moratorium is the imposition of a hold or freeze on the enrollment of new or initial Medicaid providers and suppliers of a particular provider type or the establishment of new practice locations of a particular provider type in a specific geographic area for a period of six months.  CMS may extend a temporary moratorium in six month increments.  The announcement of a moratorium will be reported in the Federal Register.

What is an MHN referral number?

If your service requires a referral, the MHN gives you an authorization number.

What is provider revalidation?

All enrolled South Carolina Healthy Connections Medicaid providers who are not Durable Medical Equipment (DME) suppliers must revalidate their enrollment criteria every five years in accordance with the Affordable Care Act. DME suppliers must revalidate every three years. Revalidation FAQs PDF

What is the payment cycle?

The payment cycle is: Wed-Mon, payments are processed on Tuesday, and payment is received as early as Friday.

What is the physical address to over-night a TAD?

The PO boxes and physical address are included in the Provider manual as well as on the mailing envelope.

For regular mail:
Medicaid Claims Receipt – NF Claims Section
Nursing Homes
P.O. Box 100122
Columbia, SC 29202-3122
Medicaid Claims Receipt – NF Claims Section
P.O. Box 67
Columbia, SC 29202
For UPS, FedEx, etc.
Medicaid Claims Receipt – NF Claims Section or CRCF Claims Section
8901 Farrow Road
Columbia, SC 29203

NOTE: Late change forms should be sent overnight or faxed, with all attachments, to (803) 870-9020. Forms should not be faxed unless they are sent past the deadline. Faxed corrections should be received no later than the third working day of each month for Nursing Home providers and the 17th day of the month for OSS providers.

What is the Web Tool’s Non-Contractual box?

The Non-Contractual box is to be selected/entered when the provider is not contracted with the beneficiary’s third party payer.

What should I do if one line does not pay on your claim?

Correct and refile that one line.

When a claim is in a denied status, can you do an adjustment?

You must wait for the rejection, and then do a correction. An adjustment can only be made to a paid claim.

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