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Administrative Services Organization (ASO) Frequently Asked Questions

  1. What is the administrative services organization (ASO)?
    The ASO module is responsible for provider management and enrollment, the adjudication of medical (non-pharmacy and non-dental) claims and prior authorizations.

Encounters, Claims and Reimbursement Questions

  1. Which providers will use the medical administrative services organization (ASO) at implementation?
    All providers who currently submit claims or encounters to SCDHHS for payment through the current MMIS legacy system will transition to the new medical ASO upon its implementation.
  2. As an enrolled Healthy Connects Medicaid provider, should I anticipate any changes to the claims and encounters process?
    Yes. The medical ASO will use a provider’s National Provider Identifier (NPI) and taxonomy to adjudicate claims. Providers will be informed of the timing for any changes to what is required to submit and adjudicate claims through Medicaid alerts, the RMMIS website and other resources provided by SCDHHS.

    An additional change is that a provider’s taxonomy code will determine a provider’s specialty and the services a provider is qualified to bill to SCDHHS. The new RMMIS will accept standard HIPAA-claim transactions. Providers should also find additional enhanced benefits and efficiency to the claims submission process.

    Updated companion and billing guides will be created and made available on the RMMIS website.

  3. Will the implementation of the medical ASO have any impact on the Healthy Connections Medicaid payment schedules?
    No. SCDHHS payment schedules will not change as a result of the medical ASO implementation.
  4. Will the implementation of the new medical ASO change to the frequency of claim payments?
    No. SCDHHS will continue to adjudicate claims according to a fixed weekly payment cycle.
  5. How will reimbursement information be provided by the ASO?
    The RMMIS will continue to provide timely reimbursement information via a secure provider web portal. 
  6. Will providers be able to continue to submit paper claims and hardcopy adjustments?
    Yes. The new system will accept paper claims and hardcopy adjustments.  However, providers will be encouraged to submit HIPAA-compliant electronic claims through the provider portal in order to receive expedited fee-for-service (FFS) payments.
  7. With the new ASO, will providers continue to be able to submit claims through a web portal?
    Yes. This functionality will be available 24/7 in the new provider portal. 
  8. Will the replacement MMIS have any impact on the processing of point-of-sale (POS) pharmacy claims?
    No. The medical ASO will continue to issue payment for pharmacy claims in the same manner as today after these claims have been adjudicated through a third-party pharmacy benefits administrator (currently Magellan). 
  9. Will the medical ASO impact the submission of dental claims? 
    No. The submission of dental claims will not change with the implementation of the medical ASO.

Prior Authorization Questions

  1. What impact will the medical ASO have on my ability to request fee-for-service (FFS) prior authorizations? 
    Providers will request prior authorizations through a new secure provider web portal provided through the Administrative Services Organization (ASO). This portal will also be used by the RMMIS to communicate the outcome of prior authorization requests. Providers shall receive additional information regarding prior authorization procedures through this portal. More information about this new portal will be provided later in the project. Prior authorization requests currently submitted to KEPRO will continue, without any changes, until the new ASO goes live.

Managed Care Questions

  1. Will the RMMIS have any impact on my contractual relationships with participating managed care organizations (MCOs)?
    Providers will need to meet all applicable South Carolina Medicaid provider enrollment requirements. As long as the provider is able to appropriately enroll in South Carolina Medicaid there will be no impact on the contractual relationship between any provider and a Medicaid MCO operating in South Carolina.

Vendor Questions

  1. Will third-party vendors be required to enter into a new trading partner agreement (TPA) with the RMMIS?      
    Yes. Third-party vendors who submit claims for providers will be required to complete a new TPA for SCDHHS. The TPA registration will be accessible through the web portal. 


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