FAQs

Effective July 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will include outpatient mental health services and Rehabilitative Behavioral Health Services (RBHS) as part of the Managed Care benefit.

Providers will be required to file claims for outpatient mental health services to the Managed Care Organizations (MCOs) for enrolled members. Providers must verify eligibility and contact the applicable MCO for prior authorization, when required, before rendering services.

  1. I am hearing and reading about changes to behavioral health services. How does this impact me? 
    While there is no change in the member benefit, there will be administrative changes for providers. Some changes include prior authorization processes and processes for filing claims.

    For dates of service on or after July 1, 2016, providers will need to verify eligibility and for some services receive prior authorization from the member’s MCO.

    For dates of service on or after July 1, 2016, providers will file claims with the member’s MCO.

  2. Why do SCDHHS approved providers have to enroll and credential with each MCO?
    All MCOs are required to enroll and credential providers as outlined in the current SCDHHS/MCO contract and 42 CFR 438.214.

  3. Will providers still have to be enrolled with SCDHHS if their clients are enrolled with an MCO?   
    Providers will have to enroll and remain enrolled in good standing with SCDHHS prior to contracting with any of the MCOs.

  4. How do I know if a service requires prior authorization?   
    Once you have contracted and enrolled with an MCO, the MCO will provide detail regarding the appropriate authorization and claim billing procedures.   

  5. Will all beneficiaries be enrolled in an MCO?   
    Some beneficiaries will remain enrolled in fee-for-service (FFS)/traditional Medicaid. For a listing of those members that are mandatorily enrolled in managed care, those that have a choice between FFS or managed care and those that cannot be enrolled in managed care, click here.

  6. I have Medicaid beneficiaries scheduled before July 1, 2016. How will this affect their appointment/treatment?   
    The change does not take place until July 1, 2016, and will not have any effect on this appointment.

  7. I have beneficiaries scheduled on or after July 1, 2016. How will this affect me?   
    Please contact the Medicaid beneficiary’s MCO for additional information regarding service authorization for any dates on or after July 1, 2016.

  8. Who do I call if I have questions regarding a beneficiary’s managed care benefits?
    If you have general questions regarding the beneficiary’s managed care benefits, please contact the beneficiary’s MCO at the phone number below:
    • Absolute Total Care: (866) 433-6041
    • BlueChoice Medicaid SC:  (866) 757-8286
    • First Choice by Select Health: (888) 559-1010
    • Molina Healthcare of South Carolina: (855) 882-3901
    • WellCare of South Carolina: (888) 588-9842

    If you have questions regarding prior authorization, please contact the appropriate MCO at the phone number below:
    • Absolute Total Care: (866) 433-6041
    • BlueChoice Medicaid SC: (866) 902-1689
    • First Choice by Select Health: (888) 559-1010, opt 4
    • Molina Healthcare of South Carolina: (855) 237-6178
    • WellCare of South Carolina: (888) 588-9842

  9. Am I notified by SCDHHS if the client is no longer enrolled with the MCO?
    All eligibility and enrollment can be verified using one of the following:
    • The SCDHHS Web Tool which is free of charge. For more information call (888) 289-0709.
    • One of the available card swipe systems.

    Upon checking eligibility, providers will be able to determine managed care participation. The Web Tool will list the name and phone number of the MCO.

    You must check eligibility before each visit as Medicaid eligibility status may change on a daily basis.

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