MCO

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. What is the location code when billing telephonic and telehealth codes?

A. For COVID-19-related telehealth services submitted to the fee-for-service benefit, providers can elect to submit either ‘02’, indicating telehealth, or place of service code they would have used if the service had been provided in person (FQHCs billing through the SCDHHS webtool should select “POS 12”). Medicaid MCOs may have additional requirements related to the place of service for COVID-19 related telehealth services.

Q. Are Healthy Connections Medicaid managed care organizations (MCOs) covering teletherapy services for their members?

A. MCOs are broadly implementing teletherapy coverage in a manner consistent with the agency's interim policies. As with all service coverage questions, the agency encourages providers to contact the MCOs' provider liaison center for any billing or documentation guidance necessary to receive reimbursement. 

Subscribe to RSS - MCO
Back to Top
Report Fraud