HMS (hms.com) is under contract with the State of South Carolina Department of Health and Human Services (SC DHHS) as South Carolina’s Medicaid Recovery Audit Contractor pursuant to Section 6411 of the Patient Protection and Affordable Care Act of 2010. Accordingly, HMS is authorized to audit provider payments and associated financial records for claims to identify underpayments and overpayments, and to recover any overpayments made to providers.
HMS has identified the following targets to date:
Complex Review Targets
- Medical necessity
- Short stays
Semi-automated Review Targets
- Ambulance during inpatient stay
- Pulmonary diagnostic procedures and E&M services
- Readmissions within 24 hours with the same DRG
Resources for South Carolina
- Frequently asked questions for the Recovery Audit Contractor (PDF)
- Provider Portal information for the Recovery Audit Contractor (PDF)
- To request setup to transmit medical records and documentation electronically please click here.
- To access the SC DHHS website please click here.
- Final Electronic Medicaid Bulletin (PDF)