The South Carolina Department of Health and Human Services (SCDHHS) is updating the Prescriber Certification of Incontinence Form (168IS) effective for dates of service on or after Oct. 1, 2026.

The updated form will now capture the prescribing provider’s National Provider Identifier (NPI) which is required to be included on incontinence supplies provider claim forms to ensure compliance with the Centers for Medicare and Medicaid Services’ Ordering, Referring and Prescribing (ORP) requirement. These requirements are outlined in the Medicaid bulletin issued May 20, 2026 (MB# 26-016). 

Requirements for Prescribing Providers  
Once the incontinence supplies provider sends the 168IS form to the prescribing provider, the prescribing provider must complete the form entirely, both initially and at every certification period. The prescribing provider must include responses to required fields on the updated form, including: 

• Name of certifying prescriber
• Prescriber’s individual NPI
• Diagnosis related to incontinence 
• Appliances used to prevent incontinence
• Confirmation of medical necessity
• Enrollment status of certifying prescriber

Required fields noted above must be completed on the form by the prescribing provider. The prescribing provider must submit the completed 168IS form to the incontinence supplies provider. The individual prescriber’s NPI must be included on the form.

Requirements for Incontinence Supplies Providers  
The incontinence supplies provider must ensure they obtain a 168IS form that is complete, accurate, signed and dated. The 168IS form must be maintained in the incontinence supplies provider’s patient health records. 

Incontinence supplies providers must ensure the individual prescribing provider’s NPI is included on the claim form. Effective Dec. 1, 2026, incontinence supplies services cannot be reimbursed if the prescribing provider’s NPI is not listed on the claim. 

ORP Enrollment Requirements
Providers prescribing incontinence supplies to Healthy Connection Medicaid members must be enrolled with Healthy Connections Medicaid, either as a fully enrolled provider or as an ORP-only provider, to complete the 168IS form. Providers must be enrolled with their individual (Type 1) NPI for ORP purposes.

A copy of the updated 168IS form can be found in the DME Services Forms section of the DME Services Manual and the Home Health Services Forms section of the Home Health Services Manual. These manuals can be found on the Provider Manuals page of SCDHHS’ website. 

South Carolina’s managed care organizations (MCOs) are responsible for authorizations, coverage and reimbursement related to the services described in this bulletin for members enrolled in an MCO.

Providers should direct any 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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