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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
Please contact their help line at (800) 726-8774 or visit them online at scthrive.org if you have questions or need assistance.
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.
1-800-MEDICARE (1-800-633-4227) Get this form in Spanish.
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.
To Receive An Enrollment Package or send a written request to Medicaid Provider Enrollment, POB 8809, Columbia, SC 29202-8809. (803) 898-2605.
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.
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.
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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