Edit 510

Issue: DOS is more than 1 year old

Claims for retroactive eligibility must be received and entered into the
claims processing system within six months of the recipient’s eligibility
being added to the Medicaid eligibility system AND be received within
three years from the date of service or date of discharge (for hospital
claims). If the above time frames are met, attach one of the following
documents listed below with each claim.
1) DHHS Form 945, which is a statement verifying the retroactive
determination furnished by the eligibility worker, or
2) The computer generated Medicaid eligibility approval letter notifying
the recipient that Medicaid benefits have been approved.
This can be furnished by the recipient or the eligibility worker. (This is
different from the Certificate of Creditable Coverage.)
For NURSING HOME PROVIDERS: Submit claim and appropriate
documentation to:
MCCS Nursing Facility Claims
Post Office Box 100112
Columbia, SC 29202
Refer to the timely filing guidelines in the appropriate section of your
provider manual.