The South Carolina Department of Health and Human Services administers Medicaid under the Healthy Connections program. In 2024, SCDHHS revised sections of its Provider Administrative and Billing Manual, including third-party liability procedures and records retention requirements. If you are not tracking those updates, you are billing against outdated rules.
Healthy Connections runs through managed care organizations:
Then there is Medicare. Palmetto GBA serves as South Carolina’s Medicare Administrative Contractor. Their Local Coverage Determinations carry documentation standards that go beyond basic Medicare requirements for certain services. Miss one required element and expect an ADR.
We verify active coverage, MCO assignment, copays, deductibles, and authorization triggers before every visit through the South Carolina Department of Health and Human Services portal and commercial payer systems.
Certified coders apply ICD 10, CPT, and HCPCS codes using payer-specific logic from BlueCross BlueShield of South Carolina and Medicare contractor policies.
We validate authorization numbers, coordination of benefits, and TPL sequencing before release. Our process maintains clean claim rates above 98 percent for in-state providers.
We submit complete clinical documentation before services that require approval from Medicaid MCOs or commercial carriers.
Every denial is analyzed within 48 hours to identify coding, documentation, or eligibility gaps. We correct errors and submit structured appeals with full support before filing limits expire.
We prioritize high balance and aging claims to improve cash velocity and reduce days in AR. Our team follows up consistently with Medicaid MCOs, Medicare, and commercial carriers across South Carolina.
We manage enrollment and recredentialing with BlueCross BlueShield of South Carolina, Healthy Connections plans, and Palmetto GBA.
We review performance data in real time and highlight changes from state Medicaid programs or major carriers. Clear reporting gives leadership full visibility into revenue performance and financial trends.
No matter the size of your clinic or the complexity of your specialty, we handle South Carolina billing with precision and care. Our team ensures claims are submitted the first time correctly, so your revenue flows uninterrupted.
Patients switch plans. Offices do not get notified. Claims get denied.
BlueCross BlueShield of South Carolina applies specialty-specific bundling and modifier logic. Orthopedics, surgery, and certain E/M scenarios require careful coding alignment.
Palmetto GBA enforces LCD requirements for services such as pain management, chiropractic, therapy, and labs.
South Carolina’s Healthy Connections Prime program serves dual-eligible beneficiaries.
Medicaid is always the payer of last resort. The 2024 SCDHHS update reinforced TPL enforcement. If another insurer exists, you must bill them first and document the attempt.
We review your claims over the past 90 days. Denial rate. AR aging. Payer mix. Coding accuracy. Most practices identify immediate, recoverable revenue during this step.
We integrate with your current system, including Epic, Athenahealth, eClinicalWorks, Kareo, and AdvancedMD
We audit enrollment status across all SC payers and immediately correct gaps.
Charges are submitted daily after passing SC specific quality control.
No claim sits untouched. No timely filing window expires without action.
You stay fully informed about collections, payer behavior, and regulatory changes affecting South Carolina providers.
We operate on a percentage-of-collections model. No setup fees. No monthly retainers. No per-claim charges. We earn only when you get paid.
We operate on a percentage-of-collections model.
From the Lowcountry to the Upstate, distance is never a barrier.
SERVING CONNECTICUT AND SURROUNDING COMMUNITIES
