№ lp_1_2_40415
File format: docx
Character count: 9716
File size: 55 KB
Administrative source document governing fax-based outpatient prior authorization requests for Medicaid services under SCDHHS as processed by Acentra Health.
Organization:
Acentra Health
Program:
South Carolina Department of Health and Human Services (SCDHHS)
Document type:
Administrative form
Purpose:
Prior authorization, recertification, change, or cancellation of outpatient Medicaid services
Submission method:
Fax
Fax number:
1-855-300-0082
Applicable services:
Mental Health Counseling, Therapies (PT, OT, SP), DME, Home Health, Hospice, Autism Spectrum Disorder
Provider identification:
National Provider Identifier (NPI) with 9-digit ZIP Code
Member identification:
Medicaid ID Number
Geographic scope:
South Carolina
Review types:
Initial, Recertification, Change, Cancel, Retrospective Prepayment Review
Governing criteria:
SCDHHS and InterQual guidelines
Associated system:
Atrezzo Connect
Submission timing:
Up to 30 days prior to scheduled services, excluding weekends and holidays
Price: 8 / 10 USD
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Year:
Not specified
Region / jurisdiction:
South Carolina
Program:
Medicaid
Document type:
Administrative form
Purpose:
Prior authorization review for inpatient services
Submitting method:
Fax
Fax number:
1-855-300-0082
Responsible organizations:
KePRO; South Carolina Department of Health and Human Services
Provider identification:
National Provider Identifier (NPI); Medicaid ID
Mandatory provider location data:
9-digit ZIP code
Review types:
Initial; Recertification; Change; Cancel; Retrospective review
Service setting:
Inpatient; freestanding inpatient psychiatric
Population focus:
Medicaid members; psychiatric services for children under 21 and adults 65 and older
Eligibility window:
Up to 30 days prior to scheduled services
Clinical information required:
Diagnosis; severity of illness; intensity of services
Approval process:
Subject to medical necessity and eligibility verification
Note:
Year
Theme:
Prior Authorization
Document Type:
Fax Form
Organization / Institution:
Acentra Health, SCDHHS
Target Audience:
Medicaid Providers
Year:
N/A
Region / City:
N/A
Topic:
Medicaid, Prior Authorization, Targeted Case Management
Document Type:
Fax Request Form
Agency / Institution:
Acentra Health
Author:
N/A
Target Audience:
Healthcare providers, Medicaid service providers
Effective Period:
N/A
Approval Date:
N/A
Amendment Date:
N/A
Year:
2026
Region / City:
South Carolina
Theme:
Medicaid, Prior Authorization
Document Type:
Form
Organization / Institution:
KEPRO-SCDHHS
Author:
KePRO
Target Audience:
Medicaid providers
Period of Validity:
Ongoing
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2019
Region / City:
North Carolina
Subject:
Data Privacy and Security
Document Type:
Best Practices Guide
Institution:
North Carolina Department of Public Instruction
Author:
Division of School Data, Research and Federal Policy
Target Audience:
NC Department of Public Instruction (DPI) staff, school and LEA staff
Period of Validity:
Ongoing
Approval Date:
August 30, 2019
Date of Modifications:
Not specified
Note:
Year
Year:
Not specified
Region / City:
Western Australia
Theme:
Healthcare, Continence Management
Document Type:
Referral Form
Organization / Institution:
Silver Chain
Author:
Not specified
Target Audience:
Medical practitioners, healthcare facilities, and clients
Period of validity:
Not specified
Approval Date:
Not specified
Date of amendments:
Not specified
Year:
2007
Region / City:
USA, Malaysia, Australia
Theme:
Telephony, Fax Solutions, Integration
Document Type:
Product Information
Organization / Institution:
FaxCore Software
Author:
FaxCore Software
Target Audience:
Small and Medium Enterprises (SMEs)
Period of Validity:
N/A
Approval Date:
N/A
Date of Changes:
N/A
Year:
2014
Region / City:
California
Document Type:
Compliance Notice
Organization:
Signature Networks PLUS
Author:
Signature Networks PLUS
Target Audience:
Medical Providers, Physician Offices
Period of Action:
Starting January 1, 2014
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
Not provided
Region / City:
Greenville, NC
Topic:
Not specified
Document Type:
Contact Information
Organization / Institution:
East Carolina University
Author:
Not provided
Target Audience:
Not specified
Effective Period:
Not specified
Approval Date:
Not provided
Amendment Date:
Not provided
Year:
2023
Region / City:
UK, Cyprus, Overseas
Subject:
Military Mental Health, Psychotherapy, Inpatient and Outpatient Services
Document Type:
Statement of Requirement
Organ / Institution:
Defence Medical Services
Author:
Defence Primary Healthcare
Target Audience:
Military Personnel, Healthcare Providers, Service Authorities
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Amendments:
Not specified
Year:
2022
Region / City:
Canberra
Topic:
Healthcare billing guidelines
Document Type:
Guideline
Organization / Institution:
Canberra Health Services
Author:
Canberra Health Services
Target Audience:
Clinical and administrative staff
Period of Validity:
Ongoing
Approval Date:
Not specified
Modification Date:
Not specified
Version:
7.0
Original release date:
December 1997
Revision date:
April 2023
Document type:
Supplemental user manual
Application:
Outpatient Pharmacy (PSO)
Organization:
Department of Veterans Affairs
Office:
Office of Information and Technology (OIT)
Program office:
Enterprise Program Management Office
Intended audience:
Pharmacists and pharmacy technicians
System context:
Veterans Affairs Medical Center
Revision history coverage:
October 2007–April 2023
Content scope:
Prescription sig creation, default quantity calculation, laser-printed pharmacy labels
Year:
1997
Region / City:
United States
Topic:
Pharmacy Management System
Document Type:
User Manual
Organization / Institution:
Department of Veterans Affairs (VA)
Author:
Department of Veterans Affairs (VA)
Target Audience:
Healthcare professionals in the VA system
Period of Validity:
1997 – Ongoing (with periodic updates)
Approval Date:
December 1997
Date of Changes:
December 2021
Year:
20__
Region / city:
Mississippi
Subject:
Mental health treatment and outpatient commitment
Document type:
Court order
Organization / institution:
Circuit Court
Author:
Circuit Court Judge
Target audience:
Defendant, legal professionals, healthcare providers
Period of validity:
12 months (unless further order of the Court)
Date of approval:
____________, 20
Date of changes:
None
Year:
2025
Region / City:
United States
Theme:
Medicare and Medicaid Programs, Hospital Outpatient Payment Systems, Ambulatory Surgical Centers
Document Type:
Final Rule
Organization / Institution:
Centers for Medicare & Medicaid Services (CMS)
Author:
Centers for Medicare & Medicaid Services (CMS)
Target Audience:
Healthcare providers, hospitals, ambulatory surgical centers
Period of Validity:
Effective March 1, 2025
Approval Date:
November 27, 2024
Amendment Date:
January 2, 2025
Note:
Description
Year:
2024
Region:
Massachusetts, USA
Document Type:
Transmittal Letter / Provider Manual Update
Issuing Organization:
Commonwealth of Massachusetts, Executive Office of Health and Human Services, Office of Medicaid
Author:
Monica Sawhney, Chief of Provider, Family, and Safety Net Programs
Target Audience:
Acute Outpatient Hospitals Participating in MassHealth
Effective Date:
July 1, 2024
Content Scope:
Revisions to drug codes, HCPCS codes, CPT codes, billing instructions, and procedural guidelines
Referenced Resources:
MassHealth Drug List, Centers for Medicare & Medicaid Services HCPCS website
Distribution:
MassHealth website and email alerts
Year:
2023
Region / City:
United States
Topic:
Outpatient Physical Therapy Standards
Document Type:
Standards Manual
Organization:
QUAD A
Author:
QUAD A
Target Audience:
Healthcare providers and facility administrators
Period of Validity:
Ongoing
Approval Date:
February 1, 2023
Date of Last Revision:
Not specified