Co-Pays & Auth
Emergency Transportation
No Auth Needed, no co-pay
This system is used everyday to log all call interactions
OMNI
Annual well care visit with primary care provider. Ages 3 to 64. One per calendar year.
10.00
Cosmetic Surgery
Who is NOONE
Use this to search for providers in the members area
Fina A Provider tool
Ambulatory Surgical Center
Prior approval may be required for some services
copay of 3.30 prior to 7/1/2024 0.00 after 7/1/2024
Work process documents can be found here
Central Point
Annual chlamydia screening. One per calendar year.
10.00
Durable Medical Equipment (DME)
Absolute Total Care
Who determines Medicaid eligibility for members
State Medicaid department (SCDHHS)
How long does it take to get a standard prior auth approved?
Within 14 days
All company information can be found here
CNET
Prenatal Doctor Visit. Needs to be completed within first trimester or 42 days of enrollment.
50.00
Hospice Care
Covered by SCDHHS
What system is used by the CM department to log member interactions and Authorizations
Trucare
Who is responsible for requesting Prior Authorizations for service?
Providers
All work based e learning can be found here
Workday Learning
Which 3 in store items are not permitted for purchase with the rewards card
alcohol, tobacco, or firearms products
Dental Services
Covered by SCDHHS/DentaQuest.
This system is the claims processing system
Amisys
Which services on the benefit grid requires a co-pay after date 7/1/2024
None
Used to assist members with account navigation
Support A User
What services can the My Rewards card be used for?
Abortion Procedure
Absolute Total Care
Where can I found out when a member should have an EPSDT/Well-Child Visit
Member handbook