South Carolina Medicaid Provider Enrollment and Credentialing: SCDHHS, the Healthy Connections MCOs, 2026 Revalidation and Palmetto GBA Medicare

A South Carolina practice usually needs every row below, and each is filed and approved on its own. The timing column repeats only what SCDHHS, the plan or the contractor has written down.

Physicians and physician assistants are licensed by the South Carolina Board of Medical Examiners within the Department of Labor, Licensing and Regulation (LLR), which publishes a licensee lookup and takes calls at (803) 896-4500 (llr.sc.gov). SCDHHS verifies the license itself as part of screening, including licenses held in other states.

SCDHHS's provider enrollment page points every applicant to one web-based application that handles four enrollment types: new enrollment, ordering/referring provider enrollment, adding a location, and revalidation. There is no paper application; the only thing that travels by fax is supporting documentation. The sequence:

1. Check the provider type table first. SCDHHS publishes a Provider Type/Specialty Table (the current file is dated August 26, 2026) and the manual warns that some provider types must sign a contractual agreement in addition to the enrollment agreement, and that some must submit proof of residency so SCDHHS can decide whether they are in-state or out-of-state providers.
2. Start the application and save the minimum fields. SCDHHS issues a Reference ID number at that point. Write it down: it is how you re-open the application, how you label documents, and what the Provider Service Center asks for.
3. Submit within 30 days. "After 30 days, the in-process application will be purged," and you start again with a new Reference ID.
4. Enter the NPI. SCDHHS asks you to obtain an NPI if you are eligible for one and share it; the page notes that a valid NPI rejected by the form is usually a typing error or a browser compatibility-view setting.
5. Fax supporting documents to Provider Enrollment at (803) 870-9022 with the Reference ID on every page.
6. Sign four agreements electronically: the participation agreement, the Electronic Funds Transfer Agreement, the W-9 and the Trading Partner Agreement. Provider types that need a separate contract are notified.
7. Pay the application fee if your provider type is institutional (physicians and non-physician practitioners are exempt; see the fee section below).

SCDHHS then screens the file: licensure verification, federal and state database checks, and a site visit "if applicable." When it approves, "official notification of enrollment will be sent to the provider." Enrollment questions go to the Provider Service Center at (888) 289-0709, option 4, or by mail to Medicaid Provider Enrollment, P.O. Box 8809, Columbia, SC 29202-8809 (Provider Administrative and Billing Manual, July 1, 2026).

Ordering, referring and prescribing (ORP) providers. Under 42 CFR 455.410(b), any physician or other professional who orders, refers or prescribes for a Healthy Connections member must be enrolled with SCDHHS, even if someone else bills the service (SCDHHS ORP page). The manual gives two routes: full enrollment, or the ORP-only pathway chosen by selecting the "Ordering/Referring" enrollment type. The ORP FAQ (v1.03, revised July 13, 2026) adds the rules practices trip over: ORP enrollment "allows for referral, ordering, or prescribing, but not billing"; it must be done with the individual Type 1 NPI, because "organizations cannot order, refer, or prescribe"; a provider already enrolled as an active billing or rendering provider with an individual NPI does not need a second ORP enrollment; and a pharmacy or DME claim naming a non-enrolled ORP NPI "will be denied." Residents, interns and fellows in teaching hospitals are in scope.

The South Carolina Medicaid Service Area. The manual defines the SCMSA as "the state of South Carolina and areas in North Carolina and Georgia within 25 miles of the South Carolina state border" (S.C. Code of State Regulations 126-200(B)). A Charlotte-area or Augusta-area practice inside that band enrolls as an in-state provider and must meet North Carolina or Georgia licensure respectively; a practice outside it receives out-of-state status, and SCDHHS allows out-of-area enrollment only "as permitted or required by state or federal law." If you also serve patients across the line, our North Carolina NCTracks guide covers the other side of that border.

The SCDHHS page does not itemize supporting documents by provider type; the application's own checklist does that once you choose a type. What the state does publish is what it signs you to (the four agreements above), what it verifies (license, NPI, exclusion databases, identity of every owner with a 5% or greater direct or indirect interest, agents and managing employees, medical directors and supervising physicians), and the bank side: an EFT agreement is one of the four signatures, and the revalidation page notes that any change to financial information triggers "a 15-day prenotification period" during which payments go out as paper checks to the payment address on file.

After enrollment, the manual requires a provider to report "any change in enrollment or contractual information (e.g., mailing or payment address, physical location, telephone number, specialty information, change in group affiliation, ownership, etc.) to the PSC within 30 days of the change." Missing that window "could result in delay of payment and/or termination of enrollment." Two South Carolina specifics: the Provider Service Center cannot change an address over the phone, so an address correction is a signed letter on business letterhead, and a new practice location is a new enrollment application, not an update. The ClaimCarePro intake list for a South Carolina file, and how to send it securely, is on what we need from you to start credentialing.

Federal rule (42 CFR 455.450) has every state Medicaid program screen providers at a limited, moderate or high categorical risk level, and the July 2026 manual spells out what each means in South Carolina. Limited screening checks provider-type requirements and license standing (including out-of-state licenses) and runs identity and exclusion checks against the Social Security Death Master File, NPPES, the OIG LEIE, SAM, the SCDHHS Excluded Provider Listing and the termination-for-cause database, with LEIE and SAM re-checked at least monthly. Moderate adds pre- and post-enrollment site visits, announced or unannounced, at any location. High adds national and state criminal background checks for the provider and every 5%-or-greater owner, plus fingerprints under 42 CFR 455.434. A provider that fits more than one level is screened at the highest, and SCDHHS raises a provider to high risk after a payment suspension, an outstanding Medicaid overpayment, an exclusion in the previous ten years, or an application within six months of a lifted moratorium.

Two South Carolina rules have teeth. Fingerprints requested by CMS or SCDHHS must be submitted "within 30 days" of the request or enrollment is denied or terminated, and a Return for Additional Information must be re-submitted "within the requested ten (10) calendar day timeframe." SCDHHS also relies in part on screening already done by Medicare contractors and other states' Medicaid programs, which is one reason a Medicare-enrolled physician's file moves faster.

Behavioral health practices should read Medicaid Bulletin MB# 23-059 (November 27, 2023). It made newly enrolling licensed independent practitioners (LIPs) and rehabilitative behavioral health services (RBHS) providers high-risk: a pre-enrollment site visit, Level 1 and Level 2 fingerprint-based checks through both SLED and the FBI, and 100% ownership disclosure. The same bulletin reinstated the 18-month inactivity rule, under which a provider ID with no claims for 18 months is terminated (not for cause; the provider may reapply). The August 2026 revalidation bulletin keeps "licensed independent practitioners, including groups and multi-specialty practices" in the rapid-revalidation track, so a counseling or psychology group in South Carolina is now on a one-year cycle.

The federal application fee in 42 CFR 455.460 falls on institutional providers only. SCDHHS's fee bulletin (MB# 22-040, December 22, 2022) lists who pays in South Carolina: ambulatory surgery centers, community mental health centers, CORFs, DME suppliers, ESRD facilities, FQHCs, home health agencies, hospices, hospitals, independent labs, pharmacies, skilled nursing facilities and rural health clinics. "Individual physicians, non-physician practitioners, and their organizations" are exempt, including a sole proprietor using an SSN and EIN, as are providers who already paid the fee to Medicare or another state's Medicaid or CHIP agency for the same enrollment, and anyone holding an approved hardship waiver.

The mechanics are South Carolina's own: SCDHHS collects the fee through the SC.gov Enterprise Payment System by debit, credit or e-check, "paper checks will not be accepted," and it collects it "before executing a provider agreement" at initial enrollment, reactivation, revalidation and when a new practice location is added. The manual lists an application being rejected outright when the agency "is not able to deposit the full amount into the state-owned account." The amount changes each January: CMS set the calendar year 2026 fee at $750 (Federal Register, December 3, 2025). We did not find a 2026 SCDHHS fee bulletin; the 2023 notice quoted $688 for that year, so confirm the current figure in the payment system before you pay.

SCDHHS publishes no processing standard for a full provider enrollment application. The closest thing to a number is in the ORP FAQ, which says ORP-only enrollment "follows similar timeframes to other standard full provider enrollment: typically, within 30 days." Treat that as the state's description of a clean file, not a guarantee, and remember the two clocks that run against you: 30 days to submit an in-process application before it is purged, and ten calendar days to answer a Return for Additional Information.

Two things make a South Carolina file stall before it is even reviewed. The manual says SCDHHS "may reject an enrollment application" when "errors or omissions are found in the application," and rejection is a dead end rather than a correction cycle ("without further review as to whether the provider or supplier qualifies"). And a moratorium denies any pending application for that provider type the day it is imposed; SCDHHS moratoria run six months at a time and can be extended.

Status. The Provider Service Center is (888) 289-0709, option 4 (Provider Enrollment and Education), Monday through Thursday 7:30 a.m. to 5 p.m. and Friday 8:30 a.m. to 5 p.m.; the ORP FAQ says enrollment can also be verified "through the SCDHHS provider portal," and SCDHHS takes written inquiries through its online contact form. Have the Reference ID ready. National guidance on reading an enrollment status is on our Medicaid provider enrollment hub.

Denials and appeals. "Approval to enroll in the Medicaid program is not automatic." SCDHHS denies any provider terminated by Medicare or another state's Medicaid or CHIP program on or after January 1, 2011, any provider whose owner was convicted of a Medicare, Medicaid or CHIP offense in the past ten years, and any applicant whose identity it cannot verify. A denial or a termination for cause can be appealed within 30 days of receiving the notice, online at scdhhs.gov/appeals, by fax to (803) 255-8206, or by mail to the Division of Appeals and Hearings; hearings are held in Columbia and the appellant or a representative must attend.

South Carolina rewrote its revalidation schedule in 2026, and the new intervals are stricter than the federal floor. The SCDHHS revalidation page states that effective June 1, 2026, providers in the high categorical risk level revalidate annually and all other providers revalidate every three years; the federal rule in 42 CFR 455.414 requires only five years (three for high risk), and the July 2026 manual still prints the five-year language, so read the revalidation page as the operative schedule. The change followed a CMS initiative in April 2026 directing states to rapidly revalidate high-risk providers; South Carolina's strategy, published that June, and Medicaid Bulletin MB# 26-027 (August 12, 2026) split "just under 76,000 providers" into a rapid track and a routine track and set 5,713 providers to be revalidated "within the next 12 months" with document review, site visits and fingerprint-based background checks.

The 2026 rapid cohort named on the revalidation page: opioid treatment programs; DME suppliers; home health agencies; hospices; skilled nursing facilities; private rehabilitative behavioral health services; licensed psychologists; licensed independent social workers (clinical practice); licensed professional counselors; licensed marriage and family therapists; licensed psycho-educational specialists; board-certified behavior analysts and assistant behavior analysts; multi-specialty groups of those practitioners; and Community Long-Term Care providers of home and community-based services. Providers whose initial enrollment predates June 1, 2025 must complete a revalidation under the strategy.

The mechanics are the same for every track: "Providers should not take any steps to revalidate their enrollment until they receive an official notification letter." The letter goes to the primary practice location on file and carries a unique revalidation number that opens the online application (about 30 minutes, with NPI, tax and ownership information at hand). The sample letter (dated August 3, 2026) says: "You have 30 days from the date of this letter to complete and submit the online portion of your revalidation application. Failure to do so will result in termination." A provider who misses it "will be considered voluntarily terminated," stops being paid, and must file a new enrollment application. High-risk providers whose fingerprinting or site visit cannot be finished inside 30 days are protected if they submit the fingerprinting appointment confirmation with the other requested documents. The PSC can mail a duplicate letter but will not read the revalidation number over the phone; use issue code REVAL. Plan recredentialing is a separate cycle, covered on our recredentialing page.

SCDHHS says "most Healthy Connections Medicaid members are enrolled in an MCO" and names five plans (SCDHHS managed care page): Absolute Total Care, Healthy Blue (BlueChoice HealthPlan), Humana Healthy Horizons, Molina Healthcare of South Carolina and First Choice by Select Health of South Carolina. On January 1, 2026 SCDHHS moved additional members, including incontinence supply and DME users, into managed care, so a practice that billed fee-for-service last year may now need plan contracts (SCDHHS managed care plans page). Historically MCOs contract by county and members pick a plan through SC Healthy Connections Choices (Managed Care provider manual supplement, 07/01/21), so which plans you need depends on where your patients live.

The rule every plan starts with is the one in the state manual: enrollment with SCDHHS "also applies to providers who contract with one or more of the South Carolina Healthy Connections Medicaid MCOs." The plans' own phrasing, from the February 6, 2026 SCDHHS all-plans deck and their manuals, is below, with the enrollment and credentialing contacts SCDHHS lists on its health plan contact page:

Two details to plan around. Humana's manual states it will accept the decisions of a credentials verification organization "on SCDHHS selection and implementation" of one; as of the reads behind this page South Carolina has no statewide Medicaid CVO, so each plan still credentials you itself. And Select Health's warning that a CAQH record alone starts nothing applies in practice to every plan here: a plan's queue begins when you ask that plan to contract. How to keep the profile they all read is on CAQH explained.

BlueCross BlueShield of South Carolina and BlueChoice run commercial and Medicaid enrollment through the same My Provider Enrollment Portal, with Provider Services at 800-868-2510 for application status; the Feb. 2026 deck's answer on timing was that "clean applications for out-of-network status may take up to 14-30 days," which is a registration figure, not a network credentialing one. National carriers follow their usual CAQH-driven steps, laid out on our payer-by-payer credentialing hub.

Unlike Virginia (60 days) or Colorado, South Carolina has no statute that tells an insurer how fast it must act on a credentialing application. We read S.C. Code Title 38, Chapter 71 and Chapter 33 in full; the only credentialing language preserves "the right of a plan to credential or re-credential a provider" (38-71-1730) and a managed care plan's ability "to credential or recredential a provider" (38-71-46). No uniform credentialing form, no provisional credentialing, no day count. That makes the plans' own figures above the only timelines in play, and it makes weekly follow-up the lever. For the neighboring states that do legislate a clock, see our Virginia PRSS guide.

South Carolina's Medicare Administrative Contractor is Palmetto GBA, headquartered in Columbia, under the Jurisdiction M contract that "processes FFS Medicare Part A and Part B claims for North Carolina, South Carolina, Virginia, and West Virginia" (CMS Jurisdiction M page). JM Part B provider enrollment is reached at 855-696-0705 (TDD 866-830-3188), "8 a.m. to 4:30 p.m. ET, Monday through Friday," and enrollment mail goes to Palmetto GBA, Mail Code AG-310, P.O. Box 100190, Columbia, SC 29202-3190, or by courier to 2300 Springdale Drive, Building One, Camden, SC 29020-1728 (Contact JMB Provider Enrollment, published January 18, 2023).

You file the CMS-855I or CMS-855B in PECOS and Palmetto processes it against the CMS timeliness standard (online with no site visit or development: 95% within 15 calendar days and all within 50). Under 42 CFR 424.521 physicians and non-physician practitioners may bill for up to 30 days before the effective date when circumstances kept them from enrolling sooner. The CMS-855 forms, PECOS and the Medicare clock are walked through on our Medicare provider enrollment page. Because SCDHHS relies in part on Medicare's screening, a physician who already holds a Palmetto-approved Medicare enrollment carries that verification into the Medicaid file.

Railroad Retirement Board beneficiaries' Part B claims also go to Palmetto GBA, but under a separate national contract. After JM approves your Part B enrollment, request a Railroad Medicare PTAN in Palmetto's PTAN Lookup and Request Tool; Palmetto builds the record from your Medicare enrollment and asks you to allow up to 30 days. The other JM states share the same contractor and the same forms: our North Carolina and Virginia guides cover their Medicaid halves.

South Carolina's process has several hard stops that do not exist in most states, and in our experience a stalled South Carolina file usually hit one of them rather than a slow reviewer. What we check before a file is submitted:

• The 30-day Reference ID clock. An application started and left open is purged, with no notice, and every document faxed under the old Reference ID is orphaned.
• Errors that trigger rejection, not correction. SCDHHS may reject for "errors or omissions" without reviewing qualifications, so the first submission has to be the clean one.
• Ten calendar days on a Return for Additional Information. A letter that sits in an unmonitored inbox for two weeks becomes a denial.
• Fingerprints or site-visit access. Thirty days to submit prints after a request; refusing or missing an announced or unannounced site visit is grounds for denial or termination.
• The wrong NPI for the role. ORP enrollment on a Type 2 NPI is invalid; a Medicaid ID assigned to a tax ID rather than the NPI will not satisfy Healthy Blue.
• Prior termination elsewhere. A termination by Medicare or another state's Medicaid program since January 1, 2011 is an automatic denial, and a prior Medicaid overpayment raises the screening level to high.
• Fee not actually settled. An institutional provider whose SC.gov payment did not clear into the state account is rejected.
• Eighteen months without a claim. The inactivity termination reinstated in 2023 ends a provider ID that was approved and never used, which is common for a second location or a part-time clinician.
• A revalidation letter sent to the old address. It goes to the primary practice location on file, the number inside is required, and the 30 days run from the letter date even if it is re-mailed.

Our process is built around those stops: one checked file compared field by field across the SCDHHS application, NPPES, LLR, the Secretary of State and CAQH before anything is signed, then follow-up with SCDHHS and every plan each week, with the representative's name, the date and the reference number logged.

Have these ready and current: the individual Type 1 NPI and, for any group, its Type 2 NPI (with NPPES addresses matching the practice); the IRS letter showing the legal name and EIN; the South Carolina license, or the North Carolina or Georgia license for a practice inside the 25-mile service area; proof of residency if your provider type requires it; DEA and CLIA where they apply; malpractice coverage; bank details for the EFT agreement; the names and identifying details of every 5%-or-greater owner, agent and managing employee, plus medical directors and supervising physicians; every service location, each of which is its own application; a complete CAQH profile with each South Carolina plan authorized; and the Palmetto GBA Medicare approval letter if you already have one.

Enrollment with SCDHHS, credentialing with a plan and the contract that lets you bill are three different approvals; our explainer on what provider credentialing is keeps them apart. The same process in other states: provider credentialing in Florida, North Carolina and Virginia.

ClaimCarePro enrolls providers with SCDHHS, including ORP-only enrollments and added locations, and carries the file through credentialing with Healthy Blue, Molina, Select Health, Absolute Total Care and Humana Healthy Horizons, Palmetto GBA Jurisdiction M Medicare, the Railroad Medicare PTAN, the new one- and three-year revalidation cycles and the commercial plans, with weekly logged follow-up on every payer. South Carolina files are billed at our published flat prices: $250 per payer application per provider, CAQH setup $250, re-credentialing $250, maintenance $99 per provider per year, or the new-practice bundle at $1,750 per provider ($1,400 each additional provider on the same group and payers). Start credentialing now and a secure start link reaches you within one business hour, or call (844) 772-8902; the full scope of each service is on our provider credentialing services page.

Updated October 29, 2026. All sources were read on October 29, 2026 unless noted. When SCDHHS, a plan or a contractor changes a published rule, its own page controls over this article. Nothing here is legal advice.

• SCDHHS, Provider Enrollment / Become a Provider (online application, Reference ID, 30-day purge, four e-signed agreements, fax, contacts): scdhhs.gov and provider enrollment information; the application itself: providerservices.scdhhs.gov
• SCDHHS, Provider Administrative and Billing Manual, dated July 1, 2026 (participation requirements, MCO rule, SCMSA, 30-day change reporting, moratoria, denial and termination grounds, ORP, background checks, screening levels, 10-day returns, adding a location, rejection, appeals): scdhhs.gov
• SCDHHS, Provider Revalidation page (intervals effective June 1, 2026, letter and 30-day rule, rapid cohort, PSC hours): scdhhs.gov; Medicaid Bulletin MB# 26-027, Provider Revalidation Updates (August 12, 2026): scdhhs.gov; sample high-risk revalidation letter: scdhhs.gov
• SCDHHS, Medicaid Bulletin MB# 22-040, 2023 Provider Enrollment Application Fee (December 22, 2022): scdhhs.gov; CMS, CY 2026 application fee notice, Federal Register (December 3, 2025): govinfo.gov
• SCDHHS, Ordering, Referring and Prescribing (ORP) Providers page: scdhhs.gov; ORP Consolidated FAQ v1.03 (revised July 13, 2026): scdhhs.gov
• SCDHHS, Medicaid Bulletin MB# 23-059, New LIP and RBHS Provider Enrollment Requirements (November 27, 2023): scdhhs.gov
• SCDHHS, Healthy Connections Medicaid Managed Care (five MCOs): scdhhs.gov; Managed Care Health Plan Contact Information: scdhhs.gov; Health Managed Care Plans (January 1, 2026 carve-in): scdhhs.gov; Managed Care provider manual supplement (07/01/21): scdhhs.gov
• SCDHHS, all-plans provider deck on the incontinence supplies and DME carve-in (February 6, 2026; Select Health, Healthy Blue, Absolute Total Care, Molina and Humana enrollment slides): scdhhs.gov
• Select Health of South Carolina (First Choice), Credentialing: selecthealthofsc.com
• Humana Healthy Horizons in South Carolina, 2025 Provider Manual, chapter 16: humana.com
• BlueCross BlueShield of South Carolina, Provider Enrollment (MyPEP): southcarolinablues.com; Absolute Total Care, Become a Provider: absolutetotalcare.com
• Palmetto GBA, Jurisdiction M Part B, Contact JMB Provider Enrollment (published January 18, 2023): palmettogba.com; CMS, A/B MAC Jurisdiction M (states served): cms.gov
• S.C. Code of Laws, Title 38, Chapter 71 (read in full; no credentialing deadline): scstatehouse.gov
• SC LLR Board of Medical Examiners: llr.sc.gov; licensee lookup: verify.llronline.com
• CMS, Medicare Program Integrity Manual, chapter 10 (read October 23, 2026 for our Medicare enrollment page): cms.gov
• 42 CFR 424.521 (read October 23, 2026 for our Medicare enrollment page): ecfr.gov; 42 CFR 455.450: ecfr.gov; 42 CFR 455.460: ecfr.gov
• Palmetto GBA, Enroll in Railroad Medicare (published January 13, 2026; read October 23, 2026 for our Medicare enrollment page): palmettogba.com

Not found, and so not stated: a South Carolina processing standard for a new full enrollment beyond the ORP FAQ's "typically, within 30 days," a 2026 SCDHHS application-fee bulletin, the SCDHHS screening-requirements table assigning each provider type a risk level, a South Carolina retroactive-enrollment rule, the Molina provider handbook (its host blocks automated reads), a county-by-county list of which MCOs operate where, and any South Carolina statute setting a deadline for credentialing decisions.