Sc uniform managed care credentialing application

• FAQs
• P&P
  • MCO Contract / P&P
  • MHN Contract / P&P
  • MCO Policy and Procedure Guide – Historical
  • Sample MCO Contract - Historical
  • MHN Policy and Procedure Guide - Historical
  • Sample MHN Contract – Historical
  • Report Templates
  • Dashboard – Historical
  • EQR Reports

  Encounter Companion Guides

  Additional Information

  Additional materials associated with the 2016 MCO Contract can be found on the following webpages:

  • https://msp.scdhhs.gov/managedcare//site-page/mco-contract-pp
  • https://msp.scdhhs.gov/managedcare/site-page/excel-report-templates

  TESTING DOCUMENTS

  Managed Care Information

  Home

  Submitted by admin on Fri, 04/19/2013 - 16:08

  The SC Department of Health and Human Services (SCDHHS) has received approval from the Centers for Medicare and Medicaid Services (CMS) to expand the Healthy Connections Choices care coordination program. This expansion effort has been implemented in support of establishing a medical home for Medicaid beneficiaries. It will require eligible beneficiaries enroll with and receive their Medicaid health benefits through one of two forms of CMS-approved managed care health care delivery models: Managed Care Organizations (MCO), or Medical Homes Networks (MHN).

  Both health care delivery models offer the same benefits as traditional fee-for-service coverage, and may also offer additional benefits and services to include unlimited doctor visits, reduced or no co-pays, access to smoking cessation classes, and programs specifically tailored for those with chronic diseases.

  Expansion implementation begins March 1, 2011 and will be phased in over a 12-month period to allow existing Healthy Connections beneficiaries currently enrolled in fee-for-service to choose a managed care health plan. Not all beneficiaries will be eligible to participate in managed care, and of those who can participate in managed care, some may only participate by choice. For additional information concerning beneficiary managed care participation, please refer to the Reference Tools.

  • Enrollment Counselor Services (SC Healthy Connections Choices)
  • Public Meeting Notices
  • Provider Bulletins
  • SCDHHS Quality Initiatives