Summary
South Carolina SCDHHS is implementing a two-track provider revalidation strategy to combat fraud and waste in the Healthy Connections Medicaid program. Approximately 5,713 high-risk providers have been prioritized for rapid revalidation within 12 months, which includes documentation review, site visits, and fingerprint-based background checks. Revalidation letters with unique codes have begun mailing to designated high-risk provider types.
Get alerts when payers change rules like this one
We check SC Medicaid - SCDHHS and other payers every day and email you when a change matches your specialty and state.
Get SC Medicaid - SCDHHS alertsPolicy Monitoring is free. No card required.
What to do
Action · 10 steps
01REQUIREMENTS:
- Immediately: All South Carolina providers in the following high-risk categories must monitor for revalidation notification letters: durable medical equipment suppliers, home health agencies, rehabilitative behavioral health services providers, licensed independent practitioners (including groups and multi-specialty practices), applied behavior analysis providers, and personal care services providers.
02- Upon receipt of revalidation letter: Obtain the unique revalidation code included in the notification and initiate the revalidation process immediately.
03Revalidation cannot begin without this code.
04- Within 12 months (by August 2027): Complete all required revalidation components including documentation submission, site visits, and fingerprint-based criminal history background checks as directed by SCDHHS.
05- Billing team and provider enrollment staff: Ensure provider credentials and enrollment records are current and accurate before revalidation letters arrive.
06Verify mailing addresses on file.
07- If no letter has been received: Do not attempt to begin revalidation.
08Wait for official SCDHHS notification via mail.
09- Consequences of inaction: Failure to complete revalidation within the designated timeframe may result in provider disenrollment from Healthy Connections Medicaid and loss of ability to bill for services rendered to Medicaid beneficiaries.
10- For questions: Contact the Provider Service Center at (888) 289-0709, option four, or visit www.scdhhs.gov/providers/revalidation.
Original notice
Provider Revalidation Updates
scdhhs.gov · Always check the source before changing claims.