Additional Operational Questions

Q. Do you temporarily waive pre-authorization/pre-certification guidelines?

A. SCDHHS has extended the timeframe for submitting additional documentation from two days to seven days. The agency continues to work closely with its quality improvement organization, KEPRO, to monitor the needs of the provider community and will make additional changes should they be necessary.

For claims submitted to MCOs, providers should confirm authorization requirements with the MCO.

Q. Do you temporarily waive or extend provider enrollment time frames?

A. Providers need to be enrolled to provide services, however SCDHHS currently allows retroactive review/enrollment for emergency services, which would apply for COVID-19 services.

Q. For Quality Measures related to wellness visits, what documentation requirements can be self-reported?

A. SCDHHS continues to use the National Committee for Quality Assurance (NCQA) technical specifications as standard for requirements related to supplemental data for hybrid measures for the Healthcare Effectiveness Data and Information Set (HEDIS).

Q. Does the South Carolina Healthy Connections Medicaid program provide or reimburse for interpreters and/or translators?

A. The Medicaid provider enrollment agreement and the SCDHHS policy manual both require providers to deliver services to non-English speaking individuals without additional compensation or support from the agency.

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