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Provider Type and Specialty Listing SOUTH CAROLINA MEDICAID PROVIDER ENROLLMENT PROVIDER TYPE/SPECIALTY LISTING Enrollment Type Provider Type Specialty Description Subspecialty Description Risk Description Category Organization Nursing Home No Specialty No Subspecialty Limited Organization Nursing Home Complex Care Services No Subspecialty Limited Organization Nursing Home ICF/IID No Subspecialty Limited Organization Nursing Home Swing Bed No Subspecialty Limited Organization Nursing Home Swing Bed/Ventilator No Subspecialty Limited Organization Nursing Home Ventilator No Subspecialty Limited Organization Community Residential Care No Specialty No Subspecialty Limited Facilities (CRCF) Organization In-Patient Hospital Psychiatric No Subspecialty Limited Organization In-Patient Hospital Psychiatric Residential Treatment No Subspecialty Limited Facility (PRTF) Organization In-Patient Hospital General No Subspecialty Limited Organization Psychiatric Residential No Specialty No Subspecialty Limited Treatment Facilities (PRTF) Organization Out-Patient Hospital No Specialty No Subspecialty Limited Organization Behavioral Health Services Developmental Evaluation Center No Subspecialty Moderate (DEC) Organization Behavioral Health Services Private Rehabilitative Behavioral Rehabilitative Behavioral High Health Services Health Services (RBHS) Not Accepting New Enrollment Applications – Temporary Moratorium on File Organization Behavioral Health Services Medical University of South Rehabilitative Behavioral Limited Carolina (MUSC) Health Services (RBHS) Page 1 of 21 04/20/2020 SOUTH CAROLINA MEDICAID PROVIDER ENROLLMENT PROVIDER TYPE/SPECIALTY LISTING Enrollment Type Provider Type Specialty Description Subspecialty Description Risk Description Category Organization Behavioral Health Services Medical University of South Targeted Case Management Limited Carolina (MUSC) (TCM) Formatted: Font: 10 pt Formatted: Normal, Widow/Orphan control Organization Behavioral Health Services Medical University of South Community Mental Health Limited Carolina (MUSC) Organization Behavioral Health Services South Carolina Department of Rehabilitative Behavioral Limited Juvenile Justice (SC DJJ) Health Services (RBHS) Organization Behavioral Health Services South Carolina Department of Psychological Testing Limited Juvenile Justice (SC DJJ) Organization Behavioral Health Services South Carolina Department of Targeted Case Management Limited Juvenile Justice (SC DJJ) (TCM) Organization Behavioral Health Services South Carolina Division of Mental Rehabilitative Behavioral Limited Health (SC DMH) Health Services (RBHS) Organization Behavioral Health Services South Carolina Division of Mental Community Mental Health Limited Health (SC DMH) Organization Behavioral Health Services South Carolina Division of Mental Targeted Case Management Limited Health (SC DMH) (TCM) Organization Behavioral Health Services South Carolina Department of Rehabilitative Behavioral Limited Social Services (SC DSS) Health Services (RBHS) Organization Behavioral Health Services South Carolina Department of Targeted Case Management Limited Social Services (SC DSS) (TCM) Organization Behavioral Health Services Department of Alcohol and Other Opioid Treatment Program Limited Drug Abuse Services (DAODAS) (OTP) Page 2 of 21 04/20/2020 SOUTH CAROLINA MEDICAID PROVIDER ENROLLMENT PROVIDER TYPE/SPECIALTY LISTING Enrollment Type Provider Type Specialty Description Subspecialty Description Risk Description Category Organization Behavioral Health Services Department of Alcohol and Other Rehabilitative Behavioral Limited Drug Abuse Services (DAODAS) Health Services (RBHS) Organization Behavioral Health Services Department of Alcohol and Other Targeted Case Management Limited Drug Abuse Services (DAODAS) (TCM) Organization Behavioral Health Services Opioid Treatment Program (OTP) Opioid Treatment Program Limited (OTP) Organization Behavioral Health Services Department of Disabilities and Rehabilitative Behavioral Limited Special Needs (DDSN) Health Services (RBHS) Organization Behavioral Health Services Department of Disabilities and Targeted Case Management Limited Special Needs (DDSN) (TCM) Atypical Organization Behavioral Health Services Department of Disabilities and Home and Community Based Limited Special Needs (DDSN) Waiver Organization Behavioral Health Services Continuum of Care for Emotionally Rehabilitative Behavioral Limited Disturbed Children Health Services (RBHS) Organization Behavioral Health Services Continuum of Care for Emotionally Targeted Case Management Limited Disturbed Children (TCM) Atypical Organization Behavioral Health Services South Carolina Department of Managed Treatment Services Limited Social Services (SC DSS) for Children (MTS) Atypical Organization Managed Care Provider (MCP) Managed Care Organization No Subspecialty Limited (MCO) Atypical Organization Managed Care Provider (MCP) Medical Home Networks (MHN) No Subspecialty Limited Atypical Organization SCDHHS Special Enrollment Dental Broker No Subspecialty Limited Atypical Organization SCDHHS Special Enrollment Eligibility Verification No Subspecialty Limited Page 3 of 21 04/20/2020 SOUTH CAROLINA MEDICAID PROVIDER ENROLLMENT PROVIDER TYPE/SPECIALTY LISTING Enrollment Type Provider Type Specialty Description Subspecialty Description Risk Description Category Atypical Organization SCDHHS Special Enrollment Miscellaneous Providers No Subspecialty Limited Atypical Organization SCDHHS Special Enrollment Buy-In No Subspecialty Limited Atypical Organization SCDHHS Special Enrollment Clawback-Part B No Subspecialty Limited Atypical Organization SCDHHS Special Enrollment Transportation Broker No Subspecialty Limited Individual Other Medical Professionals Audiologist No Subspecialty Limited Individual Other Medical Professionals Anesthesiologist Assistant (AA) No Subspecialty Limited Atypical Individual Other Medical Professionals Behavior Support Community Supports Waiver Limited Atypical Individual Other Medical Professionals Behavior Support HASCI Waiver Limited Atypical Individual Other Medical Professionals Behavior Support ID/RD Waiver Limited Individual Other Medical Professionals Board Certified Behavior Analyst No Subspecialty Limited (BCBA) Individual Other Medical Professionals Board Certified Assistant Behavior No Subspecialty Limited Analyst (BCaBA) Individual Other Medical Professionals Certified Registered Nurse No Subspecialty Limited Anesthetist (CRNA) Individual Other Medical Professionals Licensed Registered Dietician No Subspecialty Limited Individual Other Medical Professionals Licensed Independent Social No Subspecialty Limited Worker -Clinical Professional (LISW-CP) Individual Other Medical Professionals Licensed Marriage and Family No Subspecialty Limited Therapist (LMFT) Individual Other Medical Professionals Licensed Master Social Worker No Subspecialty Limited Ordering/Referring (LMSW) Page 4 of 21 04/20/2020 SOUTH CAROLINA MEDICAID PROVIDER ENROLLMENT PROVIDER TYPE/SPECIALTY LISTING Enrollment Type Provider Type Specialty Description Subspecialty Description Risk Description Category Individual Other Medical Professionals Licensed Psycho-Educational No Subspecialty Limited Ordering/Referring Specialist (LPES) Individual Other Medical Professionals Licensed Professional Counselor No Subspecialty Limited (LPC) Individual Other Medical Professionals Licensed Nurse Midwife (LPN No Subspecialty Limited Ordering/Referring Licensed by DHEC) Individual Other Medical Professionals Licensed Nurse Midwife (RN No Subspecialty Limited Ordering/Referring Licensed by DHEC) Individual Other Medical Professionals Advanced Practice Registered Certified Nurse Midwife Limited Ordering/Referring Nurse (APRN) Individual Other Medical Professionals Advanced Practice Registered Certified Nurse Practitioner Limited Ordering/Referring Nurse (APRN) Individual Other Medical Professionals Advanced Practice Registered Clinical Nurse Specialist (CNS) Limited Ordering/Referring Nurse (APRN) Individual Other Medical Professionals Occupational Therapist No Subspecialty Limited Individual Other Medical Professionals Physical Therapist No Subspecialty Moderate Individual Other Medical Professionals Physician Assistant No Subspecialty Limited Individual Other Medical Professionals Licensed Psychologist No Subspecialty Limited Atypical Individual Other Medical Professionals Psychological Services HASCI Waiver Limited Individual Other Medical Professionals Speech Pathologist No Subspecialty Limited Individual Physician, Osteopath Allergy and Immunology No Subspecialty Limited Ordering/Referring Individual Individual Physician, Osteopath Anesthesiology No Subspecialty Limited Ordering/Referring Individual Page 5 of 21 04/20/2020 SOUTH CAROLINA MEDICAID PROVIDER ENROLLMENT PROVIDER TYPE/SPECIALTY LISTING Enrollment Type Provider Type Specialty Description Subspecialty Description Risk Description Category Individual Physician, Osteopath Cardiovascular Disease No Subspecialty Limited Ordering/Referring Individual Individual Physician, Osteopath Dermatology No Subspecialty Limited Ordering/Referring Individual Individual Physician, Osteopath Dispensing Physician No Subspecialty Limited Ordering/Referring Individual Individual Physician, Osteopath Emergency Medicine No Subspecialty Limited Ordering/Referring Individual Individual Physician, Osteopath Endocrinology & Metabolism No Subspecialty Limited Ordering/Referring Individual Individual Physician, Osteopath Family Practice No Subspecialty Limited Ordering/Referring Individual Individual Physician, Osteopath Gastroenterology
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