This page information and details on the South Carolina Department of Health and Human Services (SCDHHS) provider enrollment revalidation process.
WHAT'S NEW
SCDHHS is conducting 2020 Provider Revalidation
USEFUL TIP
A list of providers in the current provider enrollment revalidation group is available for download. Providers may check this to see if they are in the current group. Organizations and systems comprising multiple providers may download this spreadsheet, which includes NPI numbers, to compare the file with their provider list file. If an organization determines their providers are up for revalidation in the current provider group, they may request revalidation information for each provider by submitting a Contact a Provider Representative inquiry or calling the Provider Service Center at (888) 289-0709, option 4.
- Background
The Centers for Medicare & Medicaid Services (CMS) has mandated that providers revalidate their enrollment information. Providers should not take any steps to revalidate their enrollment until they receive an official notification letter from the South Carolina Department of Health and Human Services (SCDHHS).
- Medicaid Bulletin: Provider Enrollment Revalidation (April 20, 2015)
The enrollment application fee of $688 is only applicable to providers that CMS has identified as institutional providers. The application fee must be collected before the revalidation provider enrollment agreement will be approved. Providers that are required to pay the fee may be exempt if the provider is already enrolled in Medicare, enrolled in another state’s Medicaid or CHIP program or submitted and received approval for a Hardship Waiver request. South Carolina Healthy Connections Medicaid recognizes and enrolls the following institutional providers:
- Ambulatory Surgery Centers
- Community Mental Health Centers
- Comprehensive Outpatient Rehabilitation Facilities
- Durable Medical Equipment
- End Stage Renal Disease Facilities
- Federally Qualified Health Centers
- Home Health Agencies
- Hospices
- Hospitals
- Independent Clinical Laboratories
- Pharmacies
- Skilled Nursing Facilities
- Rural Health Clinics
For questions about this fee, please contact the Provider Service Center (888) 289-0709, option 4.
- Resources
Communications
- Medicaid Bulletin: Provider Enrollment Revalidation (April 20, 2015)
- Example: Provider Enrollment Revalidation Letter
- FAQs
Is provider revalidation the same thing as recertifying, or updating my provider credentials?
No. Provider revalidation is different from the recertification process or credentialing updates required of some provider types.
Are all providers required to go through the revalidation process?
Yes, CMS requires all providers to revalidate every five years (DMEPOS every three years). All current South Carolina Healthy Connections Medicaid providers who were enrolled between Dec. 1, 2012-Dec. 31, 2013, are required to go through the revalidation process.
What do I need to do to prepare for revalidation?
It is highly recommended that you make sure your NPI, legacy number, tax ID, DOB, email address, mailing address, service location address, name and SSN are current with South Carolina Healthy Connections Medicaid.
Will all providers revalidate at the same time?
No. South Carolina Healthy Connections Medicaid provider revalidation will occur in five groups, with a total of 4,343 providers during 2018.
When does provider revalidation begin and how will I be notified?
South Carolina Healthy Connections Medicaid provider revalidation begins April 6, 2018. There are five groups in 2018. Providers will receive a notification letter that will include a unique revalidation code. You will use this information to access the online provider revalidation enrollment application and to follow up on the status of your revalidation through the Provider Service Center.
When is revalidation due?
This deadline will vary. Healthy Connections Medicaid providers will be issued deadlines that will vary based on their assigned group. Deadlines are indicated in the provider notification letter.
What if I do not complete my provider revalidation within the given timeframe?
If you do not fully complete the provider revalidation process within the timeframe, it is considered voluntary termination from the South Carolina Healthy Connections Medicaid program. You will no longer receive payments. You will need to re-enroll as a Medicaid provider.
If I get terminated for not completing my revalidation on time, but I eventually complete my revalidation and am reinstated, will my claims still pay for dates of service during which I was terminated?
Yes, once the record is updated and the termination status/date is removed.
How do I make sure that my address and other information are correct?
Contact the Provider Service Center at (888) 289-0709, option 4, and ask the representative for the primary practice location and payment address associated with each of your Medicaid Legacy Numbers. Please note, the call center representative cannot change your address if you identify a discrepancy. You must submit a signed letter requesting the address change on business letterhead with an authorized printed name and signature.
I have not received my letter, is there another way that I can get my revalidation code?
Contact the Provider Service Center at (888) 289-0709, option 4, to receive a duplicate notification letter.
Our organization comprises many providers. How can we tell if they are up for revalidation?
A list of providers in the current provider enrollment revalidation group is available for download. Providers may check this to see if they are in the current group. Organizations and systems comprising multiple providers may download this spreadsheet, which includes NPI numbers, to compare the file with their provider list file. If an organization determines their providers are up for revalidation in the current provider group, they may request revalidation information for each provider by submitting a Contact a Provider Representative inquiry or call the Provider Service Center at (888) 289-0709, option 4.
What if I change my Electronic Funds Transfer (EFT) Authorization Agreement during revalidation?
Please be advised that ANY change to your financial information is subject to a 15-day precertification period in which all accounts are verified by the qualifying financial institution before direct deposits are made to your account. If the financial information cannot be verified during the pre-certification period, the provider will be notified and will be required to submit an EFT Authorization Agreement, along with verification of the electronic deposit information on the financial institution’s letterhead confirming the financial information contained within the EFT Authorization Agreement. During the pre-certification period, the provider will receive reimbursement via a hard copy check. The hard copy check will be mailed to the payment address that we currently have on file. Refer to the Provider Enrollment Manual for additional EFT information or contact the Provider Service Center at (888) 289-0709, option 4.
If you have additional questions regarding provider revalidation, please contact the Provider Service Center at (888) 289-0709 and reference the issue code REVAL.
- Provider Groups
SCDHHS will notify providers when to begin the revalidation process and the specific date by which the provider's enrollment must be revalidated. Providers are divided into groups for the provider enrollment revalidation. Providers should not take any steps to revalidate their enrollment until they receive an official notification letter from SCDHHS.