Provider Manuals

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https://southc.dspace7.dspace-express.com/handle/10827/32480

The South Carolina Department of Health and Human Services publishes various provider manuals for access to Medicaid procedures and policies.

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Rural Health Clinic (RHC) Services Provider Manual
(South Carolina State Library, 2024-10-01) South Carolina Department of Health and Human Services
The purpose of this manual is to provide pertinent information to rural health clinic service providers for successful participation in the South Carolina Medicaid program. This manual provides a comprehensive overview of the program, standards, policies and procedures for Medicaid compliance.
Federally Qualified Health Center (FQHC) Behavioral Health Services Provider Manual
(South Carolina State Library, 2024-10-01) South Carolina Department of Health and Human Services
This manual is to be used for program information and requirements, billing procedures and provider services guidelines. The manual is organized as follows: General information and administration, Policies and procedures, Billing procedures, procedure codes and Administrative services.
Physicians Services Provider Manual October 1, 2024
(South Carolina State Library, 2024-10-01) South Carolina Department of Health and Human Services
The purpose of this manual is to provide pertinent information on physicians’ services and includes information on South Carolina Medicaid policies for general medical care, such as, office exams. This manual provides a comprehensive overview of the program, eligible providers, covered services and definitions, utilization management, reporting/documentation, and billing guidance.
Physicians Services Provider Manual, July 1, 2024
(2024-07-01) South Carolina Department of Health and Human Services
The purpose of this manual is to provide pertinent information on physicians services and includes information on South Carolina Medicaid policies for general medical care, such as, office exams. This manual provides a comprehensive overview of the program, eligible providers, covered services and definitions, utilization management, reporting/documentation, and billing guidance.
Provider Administrative and Billing Manual, July 1, 2024
(2024-07-01) South Carolina Department of Health and Human Services
This manual is to be used for program information and requirements, billing procedures and provider services guidelines. The manual is organized as follows: General information and administration, Policies and procedures, Billing procedures, procedure codes and Administrative services.
Dental Services Provider Manual, July 1, 2024
(2024-07-01) South Carolina Department of Health and Human Services
The purpose of this manual is to provide pertinent information to dental health service providers for successful participation in the South Carolina Medicaid program. This manual provides a comprehensive overview of the program, standards, policies and procedures for Medicaid compliance.
Community Long-Term Care Provider Manual, 2023
(2023-07-01) South Carolina Department of Health and Human Services
The mission of Long-Term Living is to provide a cost-effective alternative to institutional placement for eligible clients with long term care needs, if they choose, allowing them to remain in a community environment. This manual lists requirements that must be met in order to qualify for payment from Medicaid.
Provider Administrative and Billing Manual
(2024-04-29) South Carolina Department of Health and Human Services
This manual is to be used for program information and requirements, billing procedures and provider services guidelines. The manual is organized as follows: General information and administration, Policies and procedures, Billing procedures, procedure codes and Administrative services.
Provider administrative and billing manual
(2024-03-20) South Carolina Department of Health and Human Services
This manual is to be used for program information and requirements, billing procedures and provider services guidelines. The manual is organized as follows: General information and administration, Policies and procedures, Billing procedures, procedure codes and Administrative services.
Private rehabilitative therapy & audiological services provider manual
(2024-01-01) South Carolina Department of Health and Human Services
The purpose of this manual is to provide pertinent information to rehabilitative therapy and audiological service providers for successful participation in the South Carolina Medicaid program. This manual provides a comprehensive overview of the program, standards, policies and procedures for Medicaid compliance.
Policy and procedure guide for managed care organizations
(2024-01-01) South Carolina Department of Health and Human Services
The purpose of this guide is to document the medical and Program Policies and requirements implemented by the South Carolina Department of Health and Human Services (SCDHHS) for Managed Care Organizations (MCO) wishing to conduct business in South Carolina. In the event of any confusion or disagreement as to the meaning or intent of the requirements of the Policies and Procedures contained herein, SCDHHS shall have the ultimate authority to interpret said requirements, of the Policies and Procedures, and the SCDHHS’ interpretation shall control.
Dental services provider manual
(2024-01-01) South Carolina Department of Health and Human Services
The purpose of this manual is to provide pertinent information to dental health service providers for successful participation in the South Carolina Medicaid program. This manual provides a comprehensive overview of the program, standards, policies and procedures for Medicaid compliance.
Provider administrative and billing manual
(2024-01-01) South Carolina Department of Health and Human Services
This manual is to be used for program information and requirements, billing procedures and provider services guidelines. The manual is organized as follows: General information and administration, Policies and procedures, Billing procedures, procedure codes and Administrative services.
Policy and procedure guide for managed care organizations
(2023-10-01) South Carolina Department of Health and Human Services
The purpose of this guide is to document the medical and Program Policies and requirements implemented by the South Carolina Department of Health and Human Services (SCDHHS) for Managed Care Organizations (MCO) wishing to conduct business in South Carolina. In the event of any confusion or disagreement as to the meaning or intent of the requirements of the Policies and Procedures contained herein, SCDHHS shall have the ultimate authority to interpret said requirements, of the Policies and Procedures, and the SCDHHS’ interpretation shall control.
Pharmacy services provider manual
(2023-10-01) South Carolina Department of Health and Human Services
The State of South Carolina Department of Health and Human Services (SCDHHS) requires that providers of Pharmacy Services to South Carolina Medicaid beneficiaries adhere to all state and federal requirements regarding the practice of pharmacy. Additionally, South Carolina Medicaid-enrolled pharmacies located outside of South Carolina must adhere to all federal and state requirements specific to the state in which the pharmacy is located. This manual lists requirements that must be met in order to qualify for payment from Medicaid.
Durable medical equipment services provider manual
(2023-10-01) South Carolina Department of Health and Human Services
The South Carolina Department of Health and Human Services oversees the provision of medical supplies and equipment to eligible Medicaid beneficiaries. The purpose of this manual is to provide pertinent information to medical supplies and equipment providers for successful participation in the South Carolina Medicaid program. This manual provides a comprehensive overview of the program, standards, policies and procedures for Medicaid compliance.
Dental services provider manual
(2023-10-01) South Carolina Department of Health and Human Services
The purpose of this manual is to provide pertinent information to dental health service providers for successful participation in the South Carolina Medicaid program. This manual provides a comprehensive overview of the program, standards, policies and procedures for Medicaid compliance.
Targeted case management
(2019-04-01) South Carolina Department of Health and Human Services
Medicaid Targeted Case Management (MTCM) is a means for achieving beneficiary wellness through communication, education and service(s) identification and referral. MTCM is a time-limited process that provides an organized structured process for moving beneficiaries through the process of change and toward the goal of self-sufficiency. The MTCM process is a shared partnership between the beneficiary and/or responsible party and the Case Manager. This manual lists requirements that must be met in order to qualify for payment from Medicaid.
Program of All-Inclusive Care for the Elderly (PACE) provider manual
(2022-04-18) South Carolina Department of Health and Human Services
The Program of All-Inclusive Care for the Elderly (PACE) is an optional service under the Medicaid State plan. PACE is a capitated, managed care program. The PACE organization must provide comprehensive health care services based on his or her individual needs with the goal of enabling individuals to continue living independently in the community. This manual is to be used for program information and requirements, billing procedures and provider services guidelines.
Rehabilitative behavioral health services (RBHS) provider manual
(2023-07-01) South Carolina Department of Health and Human Services
This manual is to be used for program information and requirements, billing procedures and provider services guidelines. The manual is organized as follows: General information and administration, Policies and procedures, Billing procedures, procedure codes and Administrative services.

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