As described in the Medicaid bulletin issued May 20, 2026, (MB# 26-016), and consistent with federal law, ordering, referring or prescribing (ORP) providers must enroll with the South Carolina Department of Health and Human Services (SCDHHS) as Medicaid providers regardless of whether they submit claims for these items or services. In this update, SCDHHS is issuing guidance and providing resources for providers who prescribe pharmacy items or services.

Pharmacy Benefit ORP Rejection 
Effective Dec. 1, 2026, pharmacy claims submitted by providers who prescribe pharmacy items or services will begin to reject and payments will not be issued for claims that are submitted without federally required ORP provider information. This will impact claims for payments of items or services that were prescribed and did not properly include the National Provider Identifier (NPI) of the physician or other professional who prescribed the items or services. 

Prescriber enrollment is required for any pharmacist who provides reimbursable covered services billed to South Carolina Healthy Connections Medicaid. 

Guidance for Pharmacy Staff Receiving a Rejected ORP Claim 
Beginning Dec. 1, 2026, pharmacy staff can obtain a one-time claim rejection override by contacting the fee-for-service pharmacy technical help desk at (866) 254-1669, in order to decrease potential member impact. This help desk is open seven days a week, 24 hours a day. 

ORP Provider Training and Resources 
SCDHHS’ contracted vendor will provide one-hour live virtual training presentations on ORP to address federal requirements. Virtual training dates are listed below and are available on the agency’s ORP webpage at www.scdhhs.gov/ORP and the  Medicaid E-learning Portal.

Please visit www.medicaidelearning.com or call the Provider Service Center (PSC) at (888) 289-0709 to register for one of the training presentations. 

Training updates will continue to be posted on both the SCDHHS ORP webpage and the Medicaid E-learning Portal. 

Providers should direct questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Providers can also submit an online inquiry at https://www.scdhhs.gov/providers/contact-provider-representative.   

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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