To treat Healthy Connections Medicaid members in South Carolina, whether through fee-for-service Medicaid or one of the state’s managed care plans, a clinician must first be enrolled with the South Carolina Department of Health and Human Services. South Carolina has some rules that surprise providers, including a service area that limits out-of-state enrollment and a high-risk screening category that covers independent behavioral health clinicians. Here is how South Carolina Medicaid provider enrollment works, step by step, as of 2026.
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Who Runs Medicaid Enrollment in South Carolina
Healthy Connections Medicaid is administered by the South Carolina Department of Health and Human Services (SCDHHS), the single state agency for the program. SCDHHS handles provider enrollment itself, through the online Provider Enrollment Web Application, with questions going to the Provider Service Center at (888) 289-0709, option 4. The general rules are set out in the SCDHHS Provider Administrative and Billing Manual.
How to Enroll, Step by Step
- Get an NPI, if you are eligible for one, and a current license for your profession.
- Start the online application by entering basic information to receive a Reference ID number.
- Finish the in-process application using that Reference ID within 30 days. SCDHHS purges in-process applications after 30 days.
- Fax your supporting documents to Provider Enrollment at (803) 870-9022.
- Sign electronically, accepting the participation agreement, the Electronic Funds Transfer Agreement, the W-9, and the Trading Partner Agreement.
- Complete screening for your risk level, and respond to any request for more information within 10 calendar days.
- Wait for official notification of enrollment before you treat members under your new ID.
Documents Required
- Proof of current licensure or certification.
- A W-9, electronic funds transfer information, and a Trading Partner Agreement.
- Disclosure of ownership and control interest information.
- Proof of residency, for certain provider types, so SCDHHS can set in-state or out-of-state status.
- A separate contract, for provider types that require one.
Out-of-State Providers
Unless SCDHHS approves otherwise, providers must be located within the South Carolina Medicaid Service Area, which is South Carolina plus the parts of North Carolina and Georgia within 25 miles of the state border. Providers in that border area must meet their own state’s licensure rules. Providers outside it receive out-of-state status and can enroll only as state or federal law permits, so check your provider manual first.
Screening and Fingerprinting by Risk Level
- Limited risk: license verification and database checks, including NPPES, the OIG exclusion list, and SAM.
- Moderate risk: adds announced or unannounced pre-enrollment and post-enrollment site visits.
- High risk: adds national and state criminal background checks and fingerprints for the provider and anyone with 5% or more ownership interest.
Fingerprints must be submitted within 30 days of a request, or the application is denied.
Is There an Application Fee?
Only providers CMS identifies as institutional, such as hospitals, home health agencies, and community mental health centers, pay the fee. CMS set it at $750 for calendar year 2026. Individual physicians, non-physician practitioners, and non-physician practitioner organizations are exempt, as are providers who already paid Medicare or another state for the same location. Confirm the current amount with SCDHHS before you apply.
Managed Care: Enrollment Is Required
SCDHHS requires Medicaid enrollment even for providers who only contract with Healthy Connections managed care organizations. SCDHHS lists five plans: Absolute Total Care, Healthy Blue by BlueChoice, Humana Healthy Horizons, Molina, and First Choice by Select Health.
Behavioral Health Clinicians
South Carolina enrolls licensed independent practitioners individually: psychologists, LISW-CPs, LPCs, LMFTs, and licensed psycho-educational specialists. Each must enroll individually before linking to a group, and the group needs its own NPI and Medicaid ID. These clinicians are screened as high risk, so expect fingerprinting with SLED and the FBI and a pre-enrollment site visit. A pre-enrollment orientation, with a score of at least 90% on the knowledge review, is required before you apply. Services by clinicians who are not independently licensed are billed under an enrolled supervisor of the same discipline. Our South Carolina behavioral health billing page covers the billing side.
Dentists
Dental benefits are administered by DentaQuest as SCDHHS’s dental vendor. Dentists still enroll with SCDHHS, then use DentaQuest’s portal for eligibility checks and claims.
Ordering, Prescribing, and Referring Providers
Clinicians who order, refer, or prescribe for Healthy Connections members must enroll even if they never bill. They can choose the “Ordering/Referring” enrollment type, an abbreviated application that cannot be used to bill. Since July 1, 2026, fee-for-service claims for ordered or referred services that lack the ordering or referring provider’s NPI have begun to reject.
Revalidation
SCDHHS requires revalidation every five years, or every three years for durable medical equipment providers. Providers who do not submit a new application when due are terminated. The behavioral health manual also refers to yearly revalidation for solo practices, so confirm your schedule with Provider Enrollment.
How Long It Takes
SCDHHS states that applications are processed within 30 business days of receipt, longer when more information, a site visit, or a contract is needed. Once approved, your effective date goes back 90 days before SCDHHS received the application.
Common Reasons Applications Stall
- Letting an in-process application sit past 30 days, when it is purged.
- Missing the 10-day window to return requested information.
- Late fingerprints for a high-risk provider or owner.
- Behavioral health clinicians applying before finishing the orientation.
Let Us Handle South Carolina Medicaid Enrollment
Maximum Billing handles Healthy Connections Medicaid enrollment, managed care credentialing, CAQH, and revalidation tracking for South Carolina practices. See our behavioral health credentialing services, medical credentialing services, and dental credentialing services, or contact us to get started.
This guide reflects official SCDHHS information as of October 2026. Requirements change, so confirm current rules with SCDHHS before you apply.