Co-Pays & Auth
Systems
Rewards
Who Covers That?
Free For All
100

Emergency Transportation

No Auth Needed, no co-pay

100

This system is used everyday to log all call interactions

OMNI

100

Annual well care visit with primary care provider. Ages 3 to 64. One per calendar year.

10.00

100

Cosmetic Surgery 

Who is NOONE

100

Use this to search for providers in the members area

Fina  A Provider tool

200

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

200

Work process documents can be found here

Central Point

200

Annual chlamydia screening. One per calendar year.

10.00

200

Durable Medical Equipment (DME)

Absolute Total Care

200

Who determines Medicaid eligibility for members 

State Medicaid department (SCDHHS)

300

How long does it take to get a standard prior auth approved?

Within 14 days

300

All company information can be found here

CNET

300

Prenatal Doctor Visit. Needs to be completed within first trimester or 42 days of enrollment.

50.00

300

Hospice Care

Covered by SCDHHS

300

What system is used by the CM department to log member interactions and Authorizations

Trucare

400

Who is responsible for requesting Prior Authorizations for service?

Providers

400

All work based e learning can be found here

Workday Learning

400

Which 3 in store items are not permitted for purchase with the rewards card

alcohol, tobacco, or firearms products

400

Dental Services

Covered by SCDHHS/DentaQuest.

400

This system is the claims processing system

Amisys

500

Which services on the benefit grid requires a co-pay after date 7/1/2024

None

500

Used to assist members with account navigation 

Support A User

500

What services can the My Rewards card be used for?

  • Utilities
  • Transportation
  • Telecommunications
  • Childcare services
  • Education
  • Rent
500

Abortion Procedure

Absolute Total Care

500

Where can I found out when a member should have an EPSDT/Well-Child Visit 

Member handbook