South Carolina Pharmacy Services

Welcome to First Health Services' South Carolina Pharmacy Services Web site for beneficiaries and providers.

Paper Claims Submissions

Please note that the address for sending paper claims has changed. Future submissions of paper claims should be sent to the following address:

First Health Services
Post Office Box 85042
Richmond, VA 23261-5042

Rx Insight: Apply and Comply

Interested in the latest news pertaining to the SC Medicaid Provider Community? View the current provider newsletter.

Prescriber NPI Mandate

Effective December 9, 2009, SC Medicaid will require Pharmacy and DME providers to submit the prescriber NPI on all claims through the First Health Services Point of Sale (POS) system. Claims submitted without the prescriber’s NPI number after that date will deny.

For the prescriber NPI to adjudicate successfully on the claim submission, the prescriber’s NPI should be populated in the Prescriber ID field (NCPDP field number 411-DB) with “01” submitted in the Prescriber ID Qualifier field (NCPDP field number 466-EZ). Please refer to the SC Medicaid bulletin for further details.

Hepatitis B Program

Due to the sensational outcome from the Hepatitis C specialty care management program, First Health Services in collaboration with SC Medicaid, have implemented a Hepatitis B program to improve patient compliance and clinical outcomes for beneficiaries receiving certain specialty medications. The major focus of this program is to provide outreach to a population of South Carolina Medicaid beneficiaries who will receive high intensity intervention services to improve their care and outcomes. This program assists beneficiaries in an attempt to avoid duplication of existing services and serves as a “safety net” to identify any problems that may have occurred during the first level of services.

Pharmaceutical Care Coordination Program

Effective November 1, 2009, SCDHHS began a Pharmaceutical Care Coordination Program for children ages 6 and younger, receiving antipsychotic or sedative medications used to treat mental and behavioral health disorders. View the SC Medicaid bulletin for details.

Web PA

South Carolina Medicaid offers Pharmacy Web Prior Authorization (Web PA), a web-based application developed by First Health Services Corporation (FHSC) which allows prescribers to request PAs online and receive real-time approvals. Web PA is offered in addition to a telephone call or fax to request a PA. It offers a wide array of features including electronic submission of a prior authorization request, ability to view the status of a PA, an option to edit or delete incomplete requests, access to list of drugs that require a prior authorization, and a secure transaction of confidential information to comply with HIPAA guidelines.

Note: Prior to obtaining access to the Pharmacy Web Prior Authorization tool, prescribers or the designated delegated administrator must access the User Administration Console (UAC) to request a personal identification number (PIN), register with the PIN, and create a user id/ password. Now is the perfect opportunity to access the User Administration Console by clicking on the UAC link in the upper right hand corner of this screen. There are instructions, educational documents, and online presentations available in the Reference collection link in the upper right hand corner of this screen. First Health Services also provides a Web Support Call Center (800-241-8726) for assistance with any questions you may have during this process.

Medicaid Bulletin Subscriptions

All Medicaid Bulletins will be sent by email and can be viewed at your convenience online at www.scdhhs.gov. To make certain that you receive bulletins in the near future, please visit http://bulletin.scdhhs.gov/.

Note: If you are currently receiving bulletins from the "Medicaid Bulletins" email address, you must re-subscribe. For full details see the Medicaid Bulletin dated August 26, 2008.

Provider Support Mailbox

For assistance with claims processing for SC Medicaid through POS or to receive SC Medicaid pharmacy updates by email please contact the Provider Support Team at SCprovidersupport@magellanhealth.com.