A1. Effective April 1, 2012, the professional and outpatient facility charges for Licensed Independent Practitioners (LIPS) associated with Medicaid covered behavioral health services became part of the managed care organizations (MCO) covered responsibilities.
A2. Effective Feb. 1, 2013 the services provided by the South Carolina Department of Alcohol and Other Drug Services became part of the MCO covered responsibilities.
A3. Effective July 15, 2014 Select Health of SC (SHSC) will no longer require prior authorization for certain behavioral health outpatient therapy and medication management services for in-network/participating LIPS, psychiatrists, psychologists, and nurse practitioners. This no authorization requirement will be retro-active to January 1, 2014.
A4. Effective July 1, 2016, Rehabilitative Behavioral Health Services (RBHS) became a covered benefit under the Select Health plan. Credentialed RBHS Providers, credentialed TFC providers, DMH, credentialed DOE and DJJ providers, MUSC, and DAODAS providers can provide the following RBHS services: Behavior Modification (members under 18), Psychosocial Rehabilitative Services, Family Support Services (members 0-21), Community Integration Services (members over 18), Therapeutic Childcare (members 6 years and under), and Peer Support Services (PSS can only be provided by DMH and DAODAS for members over 18).
A5. Effective, July 1, 2017, Autism Spectrum Disorder (ASD) services became a covered benefit under the Select Health plan for members under 21 years of age. This benefit includes ASD services rendered by licensed independent practitioners (LIPs) who are approved by SC Department of Health and Human Services (SCDHHS) to provide Evidence Based Treatment (an ABA alternative therapy modality); Board Certified Behavior Analysts and Board Certified Assistant Behavior Analysts.
The following LIPs providers are permitted to render ASD services for Select Heath members once approved and registered with SC Department of Health and Human Services and Select Health:
ASD services may also be rendered by school districts that enroll with SCDHHS as ASD group providers.
A6. Effective July 1, 2017, Select Health will provide coverage for services rendered at a Psychiatric Residential Treatment Facility (PRTF) for eligible members. This benefit includes psychiatric care provided to children under age 21. If services are provided immediately before the member reaches age 21, services may continue until the earlier of the date the member no longer requires the services or the date the member reaches age 22.
Members are referred for PRTF services by a Licensed Practitioner of the Healing Arts (LPHA) via the completion of the PRTF treatment request form. The PRTF referral form can be completed by the admitting facility, current treatment provider, or referral source. For questions regarding a member who is receiving PRTF services, please contact Select Health Behavioral Health Utilization Management.
Yes. Medicaid fee-for-service will still cover all services provided by the state agencies listed below. Medicaid fee-for-service will also cover all services that the below agencies refer for, even if the treating provider is participating with an MCO.
Licensed Independent Practitioners (LIPs):
Medical professionals:
Please allow 14 calendar days for authorization decisions (BH OP, BH IP, RBHS, DAODAS IOP, and Discrete).
Please allow 7 calendar days for authorizations for PRTF.
If the service does not require prior authorization, obtaining authorization for additional/extension of services is not required.
Yes, some outpatient services require authorization:
For PAR MDs: 90870, 90882, 90887, 90889, 96101 and 96118 require prior authorization
For PAR LIPS: 96110 requires prior authorization
For DAODAS providers: check your service code spreadsheet for guidance.
FOR ALL NON-PAR PROVIDERS - prior authorization is required for any and all services.
Contact Select Health Behavioral Health at 1-866-341-8765 for information on authorization requirements.
Services for private residential treatment facilities (PRTF) are covered by Select Health as of 7/1/2017. Services for developmental evaluation centers (DEC) and adolescent treatment facilities (ATF) are not eligible for Select Health or other managed care plans and must be billed to fee-for-service.
RBHS services and psychological testing are covered by Select Health for members referred by DJJ. All of other behavioral health services for a non-incarcerated member referred by DJJ (or any other state agency) remain fee for service. Psychological testing must be performed by a licensed psychologist or a medical doctor (M.D.).
No. Per the South Carolina Department of Health and Human Services, autism services are a non-covered benefit under Medicaid managed care.
Department of Mental Health (DMH) services through MUSC IOP will continue to be handled by Medicaid’s fee-for-service program. However, non-DMH services through MUSC are covered by Select Health.
Yes, the individual provider can be credentialed, but it would have to be under his or her individual tax ID, and the provider would bill separately from the group.
No, there are no co-pays or deductibles for persons receiving behavioral health care.
Submit claims to:
Select Health of South Carolina
Claims Processing Department
P.O. Box 7120
London, KY 40742
Yes, the LPC-Intern can provide the services but the LPC-Supervisor will be responsible for signing off on all notes and submitting the claims.
If you are interested in becoming a participating provider, contact Network Management at 1-800-741-6605, ext. 54855, or 843-569-4855 (Charleston).
