Eligibility and Claims Inquiries from Providers - SC DHHS 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the Applicant/Beneficiary Name, including First, Middle, and Last names. This is crucial for identifying the individual associated with the inquiry.
  3. Fill in the Social Security Number and Date of Birth fields accurately to ensure proper processing of your request.
  4. Provide the Household Number or Application ID as required. This helps link your inquiry to existing records.
  5. In the authorization section, clearly specify what information you are requesting to be disclosed. List all relevant medical and educational records that pertain to your eligibility.
  6. Indicate from whom this information should be obtained, such as hospitals or educational institutions, ensuring comprehensive coverage of sources.
  7. Complete the 'To Whom' section by specifying the State agency responsible for processing your case.
  8. Sign and date the form at the bottom. If applicable, include signatures from a parent/guardian or legal representative.

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The income limits for Medicaid applicants can change depending on the state where they live, their marital status and the Medicaid program. In general, however, the income limits are low. In most states in 2025, the income limit for receiving long-term care at home or in a nursing home through Medicaid is $2,901/month.
The income limit for SNAP is approximately 130 percent of the federal poverty level (FPL). For example, a family of three whose income is $26,556 per year ($2,213 per month) or less may qualify for benefits. A single person who earns $15,684 per year ($1,307/month) or less may qualify for SNAP.
Electronic Claims Submission We accept all claim types electronically including primary, secondary, institutional, and corrected claims. Refer to the available guides for quick assistance: Claims Entry. Claims Status, Patient Directory, Superbill Maintenance and Coordination of Benefits.
If you or someone in your family needs health care, you should apply for Medicaid even if you are not sure of your eligibility. Some income and assets, like home ownership, may not count against you, depending on your situation. You are encouraged to apply if: You are pregnant or think you may be pregnant.
You can submit your documents in four easy steps: Visit apply.scdhhs.gov and select Document Upload tool. Enter your contact info. Enter info to help us find your Medicaid case or pending application. To upload your document, choose the type of document you are providing (if you are unsure, select Other Document)
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