SCDHHS provider administrative and billing manual (July 1, 2026) — Key contacts, enrollment, and eligibility reference

Overview

This entry summarizes the most operationally essential items from the South Carolina Department of Health and Human Services (SCDHHS) Provider Administrative and Billing Manual, effective July 1, 2026, covering the "South Carolina Healthy Connections Medicaid" program.

Key Contacts & Resources

Provider Service Center (PSC): (888) 289-0709 — for coverage questions, Web Tool access, and EDI Support Center inquiries.
South Carolina Healthy Connections Choices (enrollment counseling/MCO selection assistance): (877) 552-4642 or http://www.SCchoices.com
Medicaid Application Portal: http://apply.scdhhs.gov
State Plan for Medical Assistance: https://www.scdhhs.gov/resources/state-plan
Provider Representative Online Inquiry: https://www.scdhhs.gov/providers/contact-provider-representative
Managed Care Webpage: https://www.scdhhs.gov/providers/health-managed-care-plans
Dental Vendor Web Portal (eligibility/service history): www.dentaquest.com
Provider Education Website: http://medicaidelearning.com/
NPI Registration (NPPES): https://nppes.cms.hhs.gov

Core Systems & Forms

South Carolina Healthy Connections Medicaid Web-based Claims Submission Tool ("Web Tool"): used for submitting UB-04 and CMS-1500 claims, attaching documentation, verifying eligibility, checking claim status, and accessing remittance advice (retained for three years after payment date). Note: dental and pharmacy claims cannot be submitted via this tool.
South Carolina Healthy Connections Medicaid Trading Partner Agreement (TPA) and TPA Enrollment form — required to obtain Web Tool access; billing agents accessing remittance advice on a provider's behalf must also have a TPA on file naming the provider/billing agent relationship.

Provider Enrollment Essentials

Providers must complete an online provider enrollment application and agreement, accept terms via electronic signature (covering the participation agreement, Electronic Funds Transfer Agreement, W-9, and Trading Partner Agreement), and receive official enrollment notification.
South Carolina Medicaid Service Area (SCMSA): defined per South Carolina Code of State Regulations 126-200(B) as South Carolina plus areas of North Carolina and Georgia within 25 miles of the SC border; determines in-state vs. out-of-state provider status.
Medicaid will not issue payments to financial institutions or entities located outside the United States.

Eligibility Rules to Know

Retroactive eligibility may extend up to three months prior to the application month if the applicant met eligibility criteria and received covered services during that period.
A child born to a Medicaid-eligible pregnant member is automatically covered for one year, provided the child remains a South Carolina resident.
Dually eligible / Qualified Medicare Beneficiary (QMB) members: providers may bill Healthy Connections Medicaid for Medicare cost-sharing on Medicare-covered services regardless of Medicaid coverage status, per the State Plan.

Note: This is a partial summary highlighting only the most operationally critical contacts, tools, and rules from a much longer, multi-section source document (covering General Information, Billing Procedures, Administrative Services, Glossary, and Appendices). For complete details—including full enrollment procedures, records/documentation requirements, reimbursement methodology, program integrity, anti-fraud provisions, appeals processes, and all forms—please consult the full SCDHHS Provider Administrative and Billing Manual directly.