South Carolina Medicaid — South Carolina Healthy Connections Medicaid
| Program name | South Carolina Healthy Connections Medicaid |
|---|---|
| Provider portal | https://msp.scdhhs.gov |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the South Carolina Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in South Carolina
The Blue Cross Blue Shield Association licensee in South Carolina is BlueCross BlueShield of South Carolina. This licensee is not yet in the QuickIntell payer registry. See the full payer directory or the BCBSA national site for a provider-portal link.
Top commercial payers in South Carolina
The dominant commercial insurers operating in South Carolina, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in South Carolina
South Carolina Healthy Connections Medicaid contracts with the following managed-care organizations to administer Medicaid benefits in South Carolina. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in South Carolina
Palmetto GBA is the Medicare A/B MAC for South Carolina: Part A and Part B fee-for-service claims from South Carolina go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to CGS Administrators, LLC as the DME MAC. Home health and hospice claims are processed by Palmetto GBA. In the current Medicare Coverage Database export, 247 active LCDs from these contractors apply to South Carolina claims.
- Palmetto GBA
A/B MAC (Part A and Part B claims); Home health and hospice MAC
- CGS Administrators, LLC
DME MAC (durable medical equipment and supplies)
Selected active Palmetto GBA policies for South Carolina
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L35025 MolDX: Molecular Diagnostic Tests (MDT)
- L37379 Echocardiography
- L39671 Trigger Point Injections (TPI)
- L34415 CT of the Abdomen and Pelvis
- L39853 Outpatient Psychotherapy
- L35724 Urine Drug Testing
- L38779 MolDX: Minimal Residual Disease Testing for Cancer
- L39237 Erythropoiesis Stimulating Agents
- L33445 Removal of Benign and Malignant Skin Lesions
- L33459 Computerized Axial Tomography (CT), Thorax
- L38765 Facet Joint Interventions for Pain Management
- L37794 MolDX: Breast Cancer Index® (BCI) Gene Expression Test
Equipment, home health and hospice policies that apply in South Carolina
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L34544 Hospice - Liver Disease
- L34547 Hospice - Neurological Conditions
- L34548 Hospice Cardiopulmonary Conditions
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting South Carolina billing
- S.C. Code §38-59-20 to §38-59-260 (prompt pay — 30 business days electronic clean claim)
- S.C. Code §38-71-230 (HMO prompt pay standards)
- S.C. Code §44-7-260 (hospital financial assistance / charity care reporting)
Provider licensing & enrollment in South Carolina
Providers enroll via SCDHHS Medicaid Enrollment (MMIS). Healthy Connections MCOs credential separately via CAQH ProView.
Major health systems headquartered in South Carolina
| Health system | Headquarters |
|---|---|
| Prisma Health | Greenville, SC |
| MUSC Health (Medical University of South Carolina) | Charleston, SC |
| Spartanburg Regional Healthcare System | Spartanburg, SC |
| Roper St. Francis Healthcare | Charleston, SC |
| AnMed Health | Anderson, SC |
Frequently asked questions — South Carolina billing
What is the South Carolina Medicaid program called?
South Carolina's Medicaid program is known as South Carolina Healthy Connections Medicaid. Providers enroll and manage claims through the provider portal at https://msp.scdhhs.gov.
What is the South Carolina Medicaid timely filing limit?
South Carolina Healthy Connections Medicaid requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; South Carolina's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does South Carolina Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for South Carolina Healthy Connections Medicaid. Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in South Carolina?
The dominant commercial payers in South Carolina include UnitedHealthcare, Aetna, Cigna, Humana, AmeriHealth Caritas, along with the BCBS licensee BlueCross BlueShield of South Carolina. Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in South Carolina?
South Carolina Healthy Connections Medicaid contracts with 5 Medicaid MCOs tracked in the QuickIntell registry, including UnitedHealthcare, Centene, Molina Healthcare, Humana, AmeriHealth Caritas. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in South Carolina?
South Carolina has 3 tracked state-level statutes that affect medical billing and RCM: S.C. Code §38-59-20 to §38-59-260 (prompt pay — 30 business days electronic clean claim); S.C. Code §38-71-230 (HMO prompt pay standards); S.C. Code §44-7-260 (hospital financial assistance / charity care reporting). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in South Carolina with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to South Carolina Healthy Connections Medicaid and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from South Carolina Medicaid and the member ID card before submission.