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Get SC DHHS Provider Enrollment Manual 2018-2024
Fer 08/2017 Disclosure of Ownership and Control Interest Statement Form 12/2011 Trading Partner Agreement Instructions and Enrollment Form for Providers 01/2014 Trading Partner Agreement Instructions and Enrollment Form for Vendors and Clearinghouses 01/2014 Request for Taxpayer Identification Number and Certification 12/2014 Participation and Payment Agreement 07/2017 Preceptor/Protocol Agreement Form 01/2017 i.
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Disclosure FAQ
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Please contact their help line at (800) 726-8774 or visit them online at scthrive.org if you have questions or need assistance.
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Complete an online provider enrollment application and agreement and submit any necessary supporting documentation to Provider Enrollment via fax at 803-870-9022. Indicate Reference ID# on all supporting documentation and/or communication in reference to the submitted application.
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1-800-MEDICARE (1-800-633-4227) Get this form in Spanish.
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If you have questions or need help completing your application, call the South Carolina Healthy Connections Resource Center toll-free at 1-888-549-0820.
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To Receive An Enrollment Package or send a written request to Medicaid Provider Enrollment, POB 8809, Columbia, SC 29202-8809. (803) 898-2605.
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Requests can be made by calling the Healthy Connections Member Contact Center toll free at 1-888-549-0820 from 8 a.m.-6 p.m., Monday-Friday.
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Requests can be made by calling the Healthy Connections Member Contact Center toll free at 1-888-549-0820 from 8 a.m.-6 p.m., Monday-Friday.
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If you have any questions regarding provider enrollment and screening, please contact the Provider Service Center at (888) 289-0709, Option 4. Visit https://.scdhhs.gov/provider for additional information. Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.
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