Transcription
Nursing Facility ServicesEstablished November 1, 2005Updated October 1, 2018
Nursing Facility Services Provider ManualManual Updated 10/01/18GENERAL TABLE OF CONTENTSSECTION 1GENERAL INFORMATION AND ADMINISTRATIONSOUTH CAROLINA MEDICAID PROGRAM . 1PROVIDER ENROLLMENT . 9RECORDS / DOCUMENTATION REQUIREMENTS . 13REIMBURSEMENT. 21MEDICAID PROGRAM INTEGRITY . 31MEDICAID ANTI-FRAUD PROVISIONS / PAYMENT SUSPENSION/ PROVIDER EXCLUSIONS/TERMINATIONS . 41APPEALS . 49SECTION 2POLICIES AND PROCEDURESPROGRAM DESCRIPTION . 1PROGRAM REQUIREMENTS . 3PROGRAM SERVICES . 27SECTION 3BILLING PROCEDURESOVERVIEW . 1DHHS FORM 181 . 7NON-COVERED MEDICAL EXPENSE DEDUCTIONS . 11COINSURANCE BILLING. 19REMITTANCE ADVICE . 23ADJUSTMENT ADVICE — THE FINAL PAGES(S) OF THE REMITTANCE ADVICE . 33ADJUSTMENTS AND REFUNDS . 37SECTION 4RESIDENT RIGHTSGENERAL INFORMATION . 1§483.10 RESIDENT RIGHTS . 3§483.12 ADMISSION, TRANSFER, AND DISCHARGE RIGHTS . 17SECTION 5ADMINISTRATIVE SERVICESGENERAL INFORMATION . 1PROCUREMENT OF FORMS . 3FORMSi
Nursing Facility Services Provider ManualManual Updated 10/01/18GENERAL TABLE OF CONTENTSAPPENDICESEDIT CODES, CARCS / RARCS, AND RESOLUTIONS . APPENDIX 1SCHEDULE OF COPAYMENTS .APPENDIX 3MANAGED CARE SUPPLEMENTTHIRD-PARTY LIABILITY SUPPLEMENTii
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL x 144, 55-56,64-65ChangeUpdated Morbid obesity/bariatric paragraph.Updated edit codes 820, 906, 907, and 97708-06-18125Updated Premium Payment Project08-06-18TPLSupplement17-1808-01-18Appendix 2-Updated carrier codes08-01-18ManagedCareSupplement-Updated entire section07-01-18ChangeControlRecord1 Added DHHS Form 181 to Forms entry dated06-01-1807-01-18Appendix 13, 37, 42,45, 52-57,70, 734866-67 Updated CARC and RARC for edit codes 059,710, 738, 739, 757, 820, 821, 837, 838, 839,843, 844, 912, 914, 928, 934, and 952Updated CARC for 786Updated Resolution for 906 and 907 Updated Retro Health and Pay & ChaseUpdated TPL ResourcesUpdated TPL -Updated Notice of Admission Authorization &Change of Status for Long Term Care Forms(DHHS Form 181)05-01-18Forms-Updated Claim Reconsideration Form05-01-18Appendix 2-Updated carrier codes02-01-18Forms-Updated Health Insurance Information ReferralForm (DHHS Form 931)01-01-1851Updated Correspondence and Inquiries12-01-17Forms-Updated Claim Reconsideration Form1 of 28
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDate10-01-17SectionAppendix 1Page(s)3ChangeAdded new edit code 06309-01-17Forms-Updated forms: Complex Care Supplemental Assessment Claims Reconsideration Duplicate Remittance Advice Request Electronic Funds Transfer (EFT) AuthorizationAgreement06-01-17228-2906-01-17Forms- 05-01-17Appendix 1-Updated Provider Service Center Hours ofOperation04-01-172Updated Level of Care Criteria SectionUpdated Claim Reconsideration FormUpdated Complex Care Program SupplementalAssessment Form (DHHS 185S)2223Updated the following sections to reflect changes toMR language: Intermediate Care Facilities for Individuals withIntellectual Disabilities (ICF/IID) Estate Recovery Preadmission Screening and Resident Review(PASSAR) Level II Determination - DHHS Form 250 DDSN ResponsibilitiesUpdated KEPRO branding192004-01-1732904-01-17Forms-Updated the following sections to reflect changes toMR language: Resident Case Mix Classification Change (Form210) PASARR Level I Screening Form (Form 234) Social History for MI Level II PASARRScreening (Form 247) Social History for ID Level II PASARRScreening (Form 248)03-01-17Forms-Updated Claim Reconsideration Form12-01-16227-322 of 28Updated Complex Care Services
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL 1615-6Deleted SC Healthy Connections Checkup Programlanguage and moved sample Checkup card to SouthCarolina Healthy Connections Medicaid Cardsection09-01-16Appendix 167Updated edit code 97909-01-16Appendix 2-Updated carrier codes08-01-1612, 4, 5, 24,27Updated to reflect Medicaid Bulletin dated July 11,2016 – New Medicaid Cards08-01-16Appendix 122, 23, 66Updated edit codes 527, 532, and 96507-01-16Appendix 13, 6506-01-165135-606-01-16Appendix 1443, 14, 29,30, 63Added new edit codes 801 and 802Updated CARC for edit codes 079, 356, 357, 605,693, and 95805-01-16Appendix 16, 63, 67Updated edit codes 150, 953, 989, 99004-01-16ManagedCareSupplement18-19Replaced sample MCO cards03-01-16Appendix 119, 23Added edit codes 450 and 53202-01-161-Updated Claim Reconsideration FormUpdated edit codes 062 and 974 Updated hyperlinks throughout sectionUpdated Administration sectionUpdated Procurement of Forms sectionUpdated CLTC Regional Offices addressesUpdated the following sections to reflect MedicaidBulletin dated January 26, 2016 – Updates toSection 1 – All Provider Manuals: South Carolina Medicaid Programo Program Descriptiono SC Healthy Connections Medicaid Card(s) Records/Documentation Requirementso General Informationo Signature Policy3 of 28
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)Change Medicaid Program Integrityo Program IntegrityAppeals01-01-16119Updated to reflect Medicaid Bulletin datedDecember 9, 2015 - Charge Limits01-01-16Appendix 121Added edit code 52712-01-15Cover-11-01-15Appendix 119, 44-47 Revised edit code 507, 821, 837, 838, 83910-01-151710 Updated to add SCDHHS alertsUpdated Provider Participation10-01-15Appendix 11 Updated general instructionsUpdated the following to reflect MedicaidBulletin dated June 1, 2015 — ICD-10 ClinicalModification/ Procedure Coding Systemo Added note to general instructionso Replaced ICD-9 with ICD-CM throughoutsectionDeleted edit codes 102-109, 112-116, 503, 527,566, 791, 792December 1, 2015 - Replaced manual cover1All4, 20, 23,27, 43 09-01-15330,31 Updated SC Medicaid Web-based ClaimsSubmission Tool to reflect Medicaid Bulletindated June 19, 2015—Claim Submission WebPortal (Webtool) Enhancement SC MedicaidWeb-based Claims Submission Tool09-01-15Appendix 15, 14 Added edit codes 270 and 271 and updated editcode 110 to reflect Medicaid Bulletin dated June1, 2015 — ICD-10 ClinicalModification/Procedure Coding System07-01-15Appendix 31-203-13-1533102-01-15Forms4 of 28Updated Copayment Schedule Updated SC Medicaid Web-based ClaimsSubmission Tool (Web Tool) Updated Form 181 (04/2014) to add Resetbutton
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)Change 01-01-15Forms12-01-14112-01-143Updated Form 185SUpdated the following forms: Claim Reconsideration form Authorization Form 1819, 103-428-29Updated Provider Participation to reflect MedicaidBulletin dated October 31, 2014 – Update to Section1 of All Provider ManualsAdded the following policies: Copayment Claim Reconsideration12-01-14Forms12-01-14Appendix 16, 5012-01-14Appendix 31-212-01-14ManagedCareSupplement2Updated Managed Care Organizations (MCOs) toreflect Medicaid Bulletin dated October 31, 2014 –Update to Section 1 of All Provider Manuals11-01-1455Updated CLTC Regional Office listing11-01-14Appendix 170Updated edit code 98910-01-14133-3410-01-14Appendix 13, 31, 36,48-49, 614609-01-14Added Claim Reconsideration form22627-3009-01-14Forms-Updated edit codes 121 and 839Added to manualUpdated Medicaid Beneficiary Lock-In Program Updated the following sections: Program requirements Program Services 08-01-1416Updated edit code 079, 637, 719, 820, 821, 908,909Added new edit code 790Updated Notice of Admission, Authorization,and Change of Status for Long Term CareUpdated Complex Care SupplementalAssessment FormUpdated to reflect Medicaid Bulletin dated July 22,5 of 28
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)Change2014 – Coverage of New Screening Services forHealthy Connections Checkup 08-01-14Appendix 151, 6924, 48-51,58Deleted edit codes 845 and 969Updated edit codes 537, 837-839, 843, 844, and89207-01-14Appendix 11506-01-14Appendix 13, 1206-01-14Appendix 2All05-01-14GeneralTable ofContents1Removed DHHS county office listing05-01-1428Replaced reference to county office listing with theWhere To Go for Help web address05-01-1451 9 Updated resolution for edit code 349, 369, 509Updated resolutions for edit codes 079, 227, and 239Updated carrier codesReplaced reference to county office listing withthe Where To Go for Help web addressRemoved DHHS county office listing05-01-14Appendix 11, 2, 4, 45,46, 62, 64,92, 93Updated edit codes 007, 052, 079, 715, 719, 837,839, 977, 98404-01-14ChangeControlRecord2Deleted CMS-1500 changes from January 1, 2014for sections 3 and Forms04-01-1416, 23, 25 29-313233373941-446 of 28Updated the following sections to reflectMedicaid Bulletin dated December 3, 2013 –Discontinuation of Edit Correction FormUpdated the following sections:o Program Integrityo Recovery Audit Contractoro Beneficiary Oversighto Fraudo Referrals to the Medicaid Fraud Control Unito Updated acronym for U.S. Department ofHealth and Human Services, Office ofInspector General (HHS-OIG)
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)04-01-14244 Updated to reflect Medicaid Bulletin datedDecember 3, 2013 – Discontinuation of EditCorrection Form04-01-1431-32 127 Updated to reflect Medicaid Bulletin datedDecember 3, 2013—Discontinuation of EditCorrection FormUpdated Trading Partner AgreementUpdated SC Medicaid Web-based ClaimsSubmission Tool (Web Tool)14Updated Horry County address04-01-14504-01-14FormsChange 04-01-14Appendix -2330-3102-01-14Cover-Updated Duplicate Remittance Advice RequestformRemoved Sample Edit Correction FormUpdated Sample Remittance Advice Added edit code 527Entire section:o Updated to reflect Medicaid Bulletin datedDecember 3, 2013 – Discontinuation of EditCorrection Formo Updated to reflect Medicaid Bulletin datedNovember 30, 2013 – Transition to theCMS-1500 Health Insurance Claim Forms(02/12) version Updated the following sections to reflectMedicaid Bulletin dated December 3, 2013 –Discontinuation of Edit Correction Form:o Timely Filing Requirementso Reasonable Efforto Nursing Facility Claimso Professional, Institutional, and DentalClaimso Rejected Claimso Recoveryo Sample Forms – Reasonable Efforto Sample Forms – ECF (deleted)January 1, 2014 - Replaced manual cover7 of 28
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)02-01-1451301-01-1411, 2, 116, 23, 13-401-01-14Forms01-01-14Appendix 18 of 28ChangeUpdated Florence County office telephone numberUpdated to reflect the following bulletins: Managed Care Organizational Changes datedNovember 15, 2013 Discontinuation of Edit Correction Forms(ECFs) dated December 3, 2013Updated the following sections: Eligibility Determination South Carolina Health Connections Medicaidcard South Carolina Web-based Claims SubmissionsTool Retroactive Eligibility Program Integrity Recovery Audit Contractor Beneficiary Explanation of Medical BenefitsProgramUpdated to reflect the following bulletins: Managed Care Organizational Changes datedNovember 15, 2013 Discontinuation of Edit CorrectionForms(ECFs)s dated December 3, 2013Updated entire section to reflect the followingbulletins: Discontinuation of Edit Correction Forms(ECFs)s dated December 3, 2013 Managed Care Organizational Changes datedNovember 15, 2013Updated the following sections Correspondence and Inquiries Procurement of Forms Updated Duplicate Remittance Advice Requestand EFT Authorization Agreement formsUpdated to reflect the following bulletins: Discontinuation of Edit Correction Forms(ECFs)s dated December 3, 2013 Transition to the CMS-1500 Health Insurance
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)Change Claim Forms (02/12) version dated November20, 2014Managed Care Organizational Changes datedNovember 15, 201301-01-14ManagedCareSupplementUpdated to reflect bulletin Managed CareOrganizational Changes dated November 15, 201301-01-14TPLSupplement 12-01-13516Updated Orangeburg mailing address zip codes11-01-13517Updated York County mailing address11-01-13MCSupplement18Replaced BlueChoice MCO Medicaid card10-01-13516 Updated Orangeburg office and mailing addressUpdated York County office addressUpdated to reflect bulletin Transition to theCMS-1500 Health Insurance Claim Forms(02/12) version dated November 20, 20141710-01-13Appendix 15, 396937, 42, 44 Updated CARCs/RARCs throughout sectionAdded edit codes 110 and 725Deleted edit code 961Revised edit codes 720, 749, 750, 758, and 75910-01-13MCSupplement20 Added WellCare MCO Medicaid card andcontact information09-01-135121417 Updated Darlington County zip codeUpdated Laurens County phone numberUpdated York County office address08-01-13517 Updated York County physical address08-01-13Appendix 1150, 5172 Updated resolution for edit code 007Updated RARC and resolution for edit codes820 and 821Deleted edit codes 954, 955, and 956 Updated Colleton County office telephone07-01-135129 of 28
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)Change15 numberDeleted Newberry County PO Box address06-01-13516 Updated Richland county office telephonenumber06-01-13Appendix 15, 11, 15,33, 4030 Updated resolutions for edit codes 107, 219, 339673, 720Deleted edit code 577 04-01-1316Corrected the URL for MedicaideLearning.com04-01-13Appendix 12 20, 25, 284, 39, 52,53, 57, 597350, 5167, 69 03-01-1351403-01-13Appendix 1i2, 38, 7038, 54, 70 Changed edit code description reference DMRand MR/RD to ID/RD for edit code 052Updated CARCs for edit codes 460, 544, 569Updated resolutions for edit codes 079, 722,837, 838, 855, 865, 960Added edit codes 820, 821Updated edit code 935, 938, 939Deleted Jasper County PO Box addressDeleted Change LogChanged edit code description reference to DMRand MR/RD to ID/RD for edit codes 052, 053, 712,and 953Updated resolutions for edit codes 714, 851, and 95303-01-13ManagedCareSupplement7Deleted the Department of Alcohol and Other DrugAbuse from agencies exempt from -Added a cover page02-01-1311801-01-132-10 of 28Updated URL address for the National CorrectCoding Initiative (NCCI) Replaced Intermediate Care facility forIndividuals with Mentally Retarded (ICF/MR)with Intermediate Care facility for Individualswith Intellectual Disabilities (ICR/IID)
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)Change29 throughout sectionAdded Complex Care Service section Added Chester county Zip 4 codeUpdated Greenville PO Box address01-01-135111301-01-13Forms-Added new Complex Care Program SupplementAssessment Form (Form185S)01-01-13Appendix 1-Added Change Log for section changes12-03-1216 7-8 27-32 33-41 Updated web addresses for provider informationand provider trainingRevised heading and language to reflect newprovider enrollment requirementsUpdated Program Integrity language (entiresection)Revised heading and language for MedicaidAnti-Fraud Provisions/PaymentSuspension/Provider Exclusions/Terminations(entire section)12-03-12325Updated Electronic Funds Transfer (EFT)12-01-125315 Updated web address for provider informationUpdated McCormick county office telephonenumber12-01-12Appendix 124, 26, 27,32, 33 Updated CARCs for edit codes 538, 552, 555,561, 562, 563, 636, 637, 690Updated resolutions for edit codes 402, 561,562, 563, 721, 722, 748, 749, 752, 753, 769,791, 795, 852, 853, 856, 860, 884, 887, 892,897, 925, 926 19, 27, 40,44, 45, 47,49, 50, 55,56, 57, 59,60, 6112-01-12TPLSupplement8, 9, 17Updated web addresses for provider information andprovider training11-01-1251Updated Allendale county office address11-01-12Appendix 2-Updated carrier code list11 of 28
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)10-05-12Forms-Updated Duplicate Remittance Advice RequestForm10-01-1214Replaced back of Healthy Connections Medicaidcard10-01-12Appendix 1-Updated edit code information through document08-01-1212, 8, 9, 12,13, 15, 25,3408-01-12226, 49 40-4 46, 48 08-01-1232508-01-1251ChangeUpdated program area contact information to reflectMedicaid Bulletin dated June 29, 2012Updated SCDHHS contact information perMedicaid Bulletin dated June 29, 2012Changed the number days MCO providers arerequired to reimburse the nursing facility from30 to 90Change “Department of Facility Services” to“Division of Community and Facility Services”Updated hyperlinks 5 7Updated program area contact information toreflect Medicaid Bulletin dated June 29, 2012Removed fax request information for SCDHHSformsAdded SCDHHS forms online order informationUpdated telephone number for Greenvillecounty office08-01-12Forms- Deleted forms 140 and 142Updated Duplicate Remittance Advice RequestForm08-01-12Appendix 1- 1, 24, 60,65, 6667,70-7215, 31, 698, 10, 29,31 Updated program area contact information toreflect Medicaid Bulletin dated June 29, 2012Replaced CARC 141 or CARC A1 for edit codes52, 053, 517, 600, 924-926, 929, 954, 961, 964,966, 967, 969, 980, 985-987Added edit codes 349, 590, 978, 990, 991-995Deleted edit codes 166, 205, 573, 574, 593, 59612 of 28
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL (s)Change10, 11, 14,34, 48 Updated resolution for edit codes 170-172, 171,174, 210, 321, 711, 7981-2 7 11 17 19 Changed Division of Care Management toBureau of Managed CareUpdated program area contact information toreflect Medicaid Bulletin dated June 29, 2012Removed language limiting enrollment to 2500membersUpdate contact information for PalmettoPhysician ConnectionsAdded to “Medicaid” to BlueChoice HealthPlan08-01-12TPLSupplement5, 6, 10,17,2407-01-12Appendix 116, 484505-01-1255-8Corrected headers05-01-12Appendix 162Updated edit code 97504-01-1214Replaced the South Carolina Healthy 32122 25 02-07-12Cover-02-07-12Appendix 1182430Updated program area contact information to reflectMedicaid Bulletin dated June 29, 2012 Deleted edit codes 386 and 868Added edit codes 837, 838, 839Updated address for Marion CountyUpdated phone number for Newberry CountyUpdated DHHS Form 181Updated Remittance PackageAdded Duplicate Remittance PackageAdded Remittance AdviceAdded SC Medicaid Web-Based ClaimSubmission ToolAdded Electronic Funds TransferManual cover updated January 1, 2012 Updated edit code 402Updated edit code 544Updated edit code 636, 637, and 64213 of 28
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)Change02-01-12513Updated the Fairfield county office number02-01-12Appendix 118304249 01-01-1212-5, 20, 2401-01-1232101-01-125101-01-12Appendix 162 - Updated edit code 402Updated edit code 636, 637, and 642Updated edit code 766Updated edit code 867Deleted IVRS Information per “Retirement of TollFree Eligibility Verification Line” bulletin released11-18-11 Updated hyperlinks throughout sectionUpdated EFT informationDeleted IVRS Information per “Retirement of TollFree Eligibility Verification Line” bulletin released11-18-11Deleted IVRS Information per “Retirement ofToll Free Eligibility Verification Line” bulletinreleased 11-18-11Updated CARCs and RARCs throughout thedocument01-01-12ManagedCareSupplement9Deleted IVRS Information per “Retirement of TollFree Eligibility Verification Line” bulletin released11-18-1101-01-12TPLSupplement2Deleted IVRS Information per “Retirement of TollFree Eligibility Verification Line” bulletin released11-18-1111-01-11124Updated TPL contact information11-01-1155Updated CLTC Regional Offices addresses11-01-11TPLSupplement6, 15 12 3, 17, 1914 of 28 Changed Medicare timely filing requirement totwo years and six monthsDeleted policy to use Medicaid legacy providernumber on the same line as the Medicaid carriercodeDeleted sample legacy number from UB-04 TPLFields tableUpdated TPL contact information
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)Change10-01-11Appendix 114, 294710-01-1129, 10Added prescription drugs limit to non-coveredmedical expenses and allowable deductions09-01-11119Deleted information regarding National CorrectCoding Initiative09-01-1122339 09-01-11517Updated zip code for Spartanburg County office09-01-11Forms-09-01-11Appendix 115, 29, 3008-01-113-Updated language throughout section to reflect thecurrent billing policies including claim processing,claim submission, and copayments08-01-11Appendix 18Updated edit codes 165 and 16608-01-11ManagedCareSupplement1, 5Updated to reflect the new beneficiary copaymentrequirements in accordance with Public Noticeposted July 8, 201107-01-11513Deleted PO Box address for the Spartanburg CountyOffice07-01-11Appendix 1124356 06-01-115505-01-1118, 1105-01-1125 Added edit codes 334 and 584Updated edit code 845Added language to DDSN ResponsibilitiesUpdated Payment for Services policyUpdated the Resident Case Mix ClassificationChange form (DHHS 210)Added edit code 361, 591, 596 and 605Updated resolution for edit code 300Added edit codes 840 and 841Updated Provider Enrollment Contactinformation in edit codes 941 and 944Corrected Abbeville County PO Box Zip 4 CodeAdded language prohibiting payment to institutionsor entities located outside of the United States Added new Distinct Part for ICF/MR15 of 28
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)Change05-01-11Appendix 14304-01-11312, 13, 17 30 Updated edit code 796Removed all references to the Turn AroundDocument (TAD)Added coinsurance to the Level of Care fielddescription04-01-1156Updated telephone number for Beaufort County04-01-11Forms- Updated Electronic Funds Transfer FormUpdated Resident Case Mix ClassificationChange formDeleted sample TAD03-01-1117, 9Updated to reflect Medicaid Bulletin dated February9, 2011 – Provider Service Center03-01-11325Updated to reflect Medicaid Bulletin dated February9, 2011 – Provider Service Center03-01-1154 5 - 67 03-01-11Appendix 103-01-11Appendix 2-03-01-11TPLSupplement17 24, 25 Updated to reflect Medicaid Bulletin datedFebruary 9, 2011 – Provider Service CenterAdded toll free number for Aiken CountyAdded SCDHHS Medicaid Provider ServiceCenter (PSC) information at top of each page inheader sectionMade change to Edit Code 990 descriptionUpdated alpha and numeric carrier code lists toreflect Web site update on 12/14/10Changed the name of the Provider OutreachWeb site to Provider Enrollment and EducationUpdated the descriptions for Form130s02-01-11Appendix 13Added edit codes 079 and 08001-01-1117 19-20 26 01-01-1116 of 283Updated the South Carolina Medicaid Webbased Claims Submission Tool sectionUpdated to reflect Medicaid Bulletin datedDecember 8, 2010 – Information on NCCI EditsUpdated electronic remittance package
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)ChangeinformationUpdated to reflect Medicaid Bulletin datedDecember 10, 2010 – Requests for DuplicateRemittance Package25 Added toll-free telephone number for Saluda county01-01-1151301-01-11Forms-Added Duplicate Remittance Request Form01-01-11Appendix 19Added edit codes 165 and 16601-01-11TPLSupplement8, 108 10 13 15 15 12-01-10Cover-12-01-10222 & 23Removed references to Dental claimsRemoved language to contact program areas formissing carrier codesAdded reference to CMS-1500 for correctingedit code 151 on the ECFAdded edit code 165 to other TPL-relatedinsurance edit codes listUpdated Retro Medicare section to include thefollowing:o Changed the timely filing requirement from90 days of the invoice to 30 daysoAdded SCDHHS TPL recovery languageUpdated the Retro Health and Pay & ChasesectionReplaced “Medicaid Provider Manual” with “SouthCarolina Healthy Connections (Medicaid)” Replaced Resident Assessment Protocols(RAPs) with Care Area Assessments (CAAs)Replaced Minimum Data Set (MDS) 2.0 withMinimum Data Set (MDS) 3.012-01-10Appendices-Replaced “South Carolina Medicaid” with “SouthCarolina Healthy Connections (Medicaid)” in theheaders12-01-10Supplements-Replaced “South Carolina Medicaid” with “SouthCarolina Healthy Connections (Medicaid)” in theheaders11-01-10Appendix 18 Edit code 202: added information to Resolution17 of 28
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)1632Change 5152 11-01-1010-01-10TPLSupplement1sectionEdit codes 421 and 424 deletedEdit code 733 information updated in Resolutionsection: “Adjust the net charge in field” changedfrom 26 to 29Deleted edit code 959Deleted edit codes 962 and 9633, 8, 13-14,18-19 6, 15-17 - 17 10 Correct McCormick county office street addressUpdated to reflect Medicaid Bulletin dated July8, 2010 – Transfer of the Dental ProgramAdministration to DentaQuestUpdated to reflect Medicaid Bulletin datedSeptember 13, 2010 – Changes to the ThirdParty Liability Medicare Recovery CycleRemoved all reference to the SCHIP program toreflect Medicaid Bulletin dated August 19, 2010– Changes to the Healthy Connections Kids(HCK) ProgramUpdated Program Description sectionUpdated the SC Medicaid Web-Based ClaimsSubmission Tool section to reflect MedicaidBulletin dated July 8, 2010-Transfer of theDental Program Administration to DentaQuestUpdated Freedom of Choice section10-01-1051110-01-10Forms-Deleted the Mini-Mental State Exam10-01-10ManagedCareSupplement- 12 34561317 18 of 28Removed all references to the SCHIP programto reflect Medicaid Bulletin dated August 19,2010 – Changes to the Healthy ConnectionsKids (HCK) ProgramUpdated Managed Care OverviewUpdated Managed Care Organizations and CoreBenefits paragraphsUpdated MCO Program ID card paragraphUpdated MHN Program ID card paragraphUpdated Core BenefitsUpdated Exempt ServicesUpdated OverviewDeleted “Medicaid Managed” from “Current
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)ChangeMedicaid Managed Care Organizations” headingand following paragraph09-01-1055 8 11 Removed County Commissioner’s Buildingfrom the Aiken County addressDeleted Dorchester County physical addresstelephone numberRemoved Highway 28 N from the McCormickCounty address09-01-10Appendix 19- Added edit code 225Removed all references to the ADA Claim in theResolution column09-01-10TPLSupplement12 13 18 Updated the Dental Paper Claims section todelete paper claims submission instructions andadded the DentaQuest contact informationUpdated the Web-Submitted Claims section withthe exception to Dental claimsUpdated the TPL Resources section to includethe DentaQuest contact information for , 9, 11-13 6 2051, 52 59 08-01-10Appendix 107-01-105-07-01-10Appendix 13235Removed July 1 entry for Appendix 2Updated the zip codes for Aiken, Edgefield,McCormick, Newberry, and Saluda countiesUpdated the address for Barnwell CountyUpdated the telephone number for BeaufortCountyDeleted edit code 520Deleted Provider Enrollment e-mail addressfrom codes 941 and 944Changed resolution for edit code 994Updated telephone numbers zip codes for multiplecounty offices Updated edit code 714Updated edit code 73819 of 28
Nursing Facility Services Provider ManualManual Updated 10/01/18CHANGE CONTROL RECORDDateSectionPage(s)06-01-
Nursing Facility Services Provider Manual Manual Updated 10/01/18 CHANGE CONTROL RECORD 1 of 28 Date Section Page(s) Change 10-01-18 2 29 Updated Morbid obesity/bariatric paragraph. 10-01-18 Appendix 1 44, 55-56, 64-65 Updated edit codes 820, 906, 907, and 977 08-06-18 1 25 Updated Premium Payment Project 08-06-18 TPL Supplement
