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SC Medicaid - SCDHHSMedicaid · Documentation · Provider Communication · SCHigh impact

Prescriber Certification of Incontinence Form Update

Effective date
Oct 1, 2026
Identified
Oct 3, 2026

Summary

South Carolina Medicaid (Healthy Connections) updated the Prescriber Certification of Incontinence Form (168IS) to require capture of the prescribing provider's individual NPI on the form and all related claims. Effective December 1, 2026, incontinence supplies claims will be denied if the prescriber's NPI is not included. The billing team must ensure all 168IS forms are complete with prescriber NPI and that claims include this identifier.

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What to do

Action · 9 steps
01REQUIREMENTS: - By December 1, 2026: Billing team must update claim submission processes to require and validate the prescribing provider's individual NPI on all incontinence supplies claim forms.
02Update billing system validation rules to reject claims without this identifier.
03- Immediately: Notify all prescribing providers in South Carolina that the updated 168IS form (available on SCDHHS website) must be completed with their individual NPI, diagnosis, appliances, medical necessity confirmation, and enrollment status.
04Provide providers with the updated form from the DME Services Manual or Home Health Services Manual sections of SCDHHS Provider Manuals.
05- Implement verification process: Before submitting claims, ensure the 168IS form is obtained from prescribers, is complete, accurately filled, signed, and dated, with the individual prescriber's NPI clearly documented.
06Maintain the form in patient health records.
07- Communicate with prescribing providers: Clarify that providers must be enrolled with Healthy Connections Medicaid (either as fully enrolled or ORP-only provider) using their individual Type 1 NPI to complete the certification form.
08CONSEQUENCES: As of December 1, 2026, any incontinence supplies claim submitted without the prescribing provider's NPI will be denied for reimbursement.
09Claims submitted between October 1, 2026 and November 30, 2026 should include NPI to prepare for the mandatory enforcement date.

Original notice

Prescriber Certification of Incontinence Form Update
scdhhs.gov · Always check the source before changing claims.
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SC Medicaid - SCDHHS policiesSC policy changes

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