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PROVIDER FORMS
Can’t find a form on this page? Try the looking in the provider portal.The portal has several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE South Country is committed to identifying, preventing, correcting, and reporting fraud, waste, and abuse. The efforts undertaken as part of these processes are collaborative in nature and involve training and education, monitoring, audits including automated claims system checks, membership, and participation in the Minnesota Healthcare Fraud Taskforce, and more. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service. SOUTH COUNTRY HEALTH ALLIANCE 1-866-567-7242 (toll-free) TTY 1-800-627-3529 or 711 ABILITYCARE (HMO SNP) AbilityCare Coverage and Eligibility. AbilityCare is a Medicare Advantage Special Needs BasicCare (SNBC) program for people with disabilities who live in our 12-county service area. DHS-3427-ENG (LTC SCREENING DOCUMENT page 3 of 5 dhs-3427-eng 10-15. section d: screening/assessment results (alt 4) 75. assessment results and exit reasons. 75a. 75b. 76.effective date
DHS-3427-ENG (LTC SCREENING DOCUMENT *dhs-3427-eng* dhs-3427-eng 9-17 page 1 of 5 ltc screening document – ac, bi, cac, cadi, ecs, ew, mhm, msc+, msho, snbc document control number social security number MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. SOUTH COUNTRY HEALTH ALLIANCE PROVIDER PORTAL Helping our provider network improve efficiency, quality, and the patient experience. As a provider and medical professional, the South Country Health Alliance provider portal will give you the ability to check patient's eligibility, coverage, check claim status, view authorizations and referrals, and more. SOUTH COUNTRY HEALTH ALLIANCE South Country Health Alliance members may be eligible for non-emergency medical transportation (NEMT) services to help them get to and from their health care appointments. GOALS, INTERVENTIONS, AND OUTCOMES Pg. 1 of 2 . Care Coordination Training Handout . Goals, Interventions, and Outcomes . Definition of GOALS . Goals are broad-based statements that indicate what you hope to accomplish while MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application PROVIDER GUIDE TO BILLING MEDICATION RECONCILIATION 05/01/2014 v.2 Page 2 Medicare-certified Agency: Per DHS, if a county Public Health Nurse is providing a Public Health Nursing Clinic visit, the county agency would bill utilizing the S9123 code. The DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER … *DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. SOUTH COUNTRY HEALTH ALLIANCE PROVIDER PORTAL Helping our provider network improve efficiency, quality, and the patient experience. As a provider and medical professional, the South Country Health Alliance provider portal will give you the ability to check patient's eligibility, coverage, check claim status, view authorizations and referrals, and more. SOUTH COUNTRY HEALTH ALLIANCE South Country Health Alliance members may be eligible for non-emergency medical transportation (NEMT) services to help them get to and from their health care appointments. GOALS, INTERVENTIONS, AND OUTCOMES Pg. 1 of 2 . Care Coordination Training Handout . Goals, Interventions, and Outcomes . Definition of GOALS . Goals are broad-based statements that indicate what you hope to accomplish while MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application PROVIDER GUIDE TO BILLING MEDICATION RECONCILIATION 05/01/2014 v.2 Page 2 Medicare-certified Agency: Per DHS, if a county Public Health Nurse is providing a Public Health Nursing Clinic visit, the county agency would bill utilizing the S9123 code. The DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER … *DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms.PROVIDER FORMS
Can’t find a form on this page? Try the looking in the provider portal.The portal has several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE South Country is committed to identifying, preventing, correcting, and reporting fraud, waste, and abuse. The efforts undertaken as part of these processes are collaborative in nature and involve training and education, monitoring, audits including automated claims system checks, membership, and participation in the Minnesota Healthcare Fraud Taskforce, and more. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service. SOUTH COUNTRY HEALTH ALLIANCE 1-866-567-7242 (toll-free) TTY 1-800-627-3529 or 711 ABILITYCARE (HMO SNP) AbilityCare Coverage and Eligibility. AbilityCare is a Medicare Advantage Special Needs BasicCare (SNBC) program for people with disabilities who live in our 12-county service area. DHS-3427-ENG (LTC SCREENING DOCUMENT page 3 of 5 dhs-3427-eng 10-15. section d: screening/assessment results (alt 4) 75. assessment results and exit reasons. 75a. 75b. 76.effective date
DHS-3427-ENG (LTC SCREENING DOCUMENT *dhs-3427-eng* dhs-3427-eng 9-17 page 1 of 5 ltc screening document – ac, bi, cac, cadi, ecs, ew, mhm, msc+, msho, snbc document control number social security number MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE Do you need help finding a dentist or scheduling a dental appointment? Delta Dental of Minnesota’s Customer Service can help! Call Customer Service toll-free at 1-800-774-9049 (TTY users call 711).. A Customer Service Representative can help you find a dental provider in your area, including a general dentist, oral surgeon, or orthodontist. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service. MINNESOTA UNIFORM CREDENTIALING APPLICATION Initial Application – 09/2001; Revised 04/2002; Revised 06/2005; 01/2007; 08/2011, Revised 10/2016 Page 1 of 24 Minnesota Uniform Credentialing Application MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application DHS-3427-ENG (LTC SCREENING DOCUMENT page 3 of 5 dhs-3427-eng 10-15. section d: screening/assessment results (alt 4) 75. assessment results and exit reasons. 75a. 75b. 76.effective date
DHS-3427-ENG (LTC SCREENING DOCUMENT *dhs-3427-eng* dhs-3427-eng 9-17 page 1 of 5 ltc screening document – ac, bi, cac, cadi, ecs, ew, mhm, msc+, msho, snbc document control number social security number DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER … *DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE Do you need help finding a dentist or scheduling a dental appointment? Delta Dental of Minnesota’s Customer Service can help! Call Customer Service toll-free at 1-800-774-9049 (TTY users call 711).. A Customer Service Representative can help you find a dental provider in your area, including a general dentist, oral surgeon, or orthodontist. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service. MINNESOTA UNIFORM CREDENTIALING APPLICATION Initial Application – 09/2001; Revised 04/2002; Revised 06/2005; 01/2007; 08/2011, Revised 10/2016 Page 1 of 24 Minnesota Uniform Credentialing Application MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application DHS-3427-ENG (LTC SCREENING DOCUMENT page 3 of 5 dhs-3427-eng 10-15. section d: screening/assessment results (alt 4) 75. assessment results and exit reasons. 75a. 75b. 76.effective date
DHS-3427-ENG (LTC SCREENING DOCUMENT *dhs-3427-eng* dhs-3427-eng 9-17 page 1 of 5 ltc screening document – ac, bi, cac, cadi, ecs, ew, mhm, msc+, msho, snbc document control number social security number DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER … *DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Do you need help finding a dentist or scheduling a dental appointment? Delta Dental of Minnesota’s Customer Service can help! Call Customer Service toll-free at 1-800-774-9049 (TTY users call 711).. A Customer Service Representative can help you find a dental provider in your area, including a general dentist, oral surgeon, or orthodontist. PHARMACY INFORMATION Pharmacy Help Desk Pharmacy Claims Online Drug Search; PerformRx. Medicaid 1-866-935-8874. Medicare 1-866-935-6681: 2021; Medicaid BIN # 019595; Medicaid PCN 6180000 PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage.PROVIDER FORMS
Can’t find a form on this page? Try the looking in the provider portal.The portal has several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE South Country is committed to identifying, preventing, correcting, and reporting fraud, waste, and abuse. The efforts undertaken as part of these processes are collaborative in nature and involve training and education, monitoring, audits including automated claims system checks, membership, and participation in the Minnesota Healthcare Fraud Taskforce, and more. SOUTH COUNTRY HEALTH ALLIANCE Service Contact; Medical/Behavioral Health Services or Chiropractic: South Country Provider Contact Center 1-888-633-4055 Provider Manual Chapter 4, Provider Billing SOUTH COUNTRY HEALTH ALLIANCE 1-866-567-7242 (toll-free) TTY 1-800-627-3529 or 711PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. SOUTH COUNTRY HEALTH ALLIANCE South Country Health Alliance members may be eligible for non-emergency medical transportation (NEMT) services to help them get to and from their health care appointments. MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE Do you need help finding a dentist or scheduling a dental appointment? Delta Dental of Minnesota’s Customer Service can help! Call Customer Service toll-free at 1-800-774-9049 (TTY users call 711).. A Customer Service Representative can help you find a dental provider in your area, including a general dentist, oral surgeon, or orthodontist. SOUTH COUNTRY HEALTH ALLIANCE PROVIDER PORTAL Helping our provider network improve efficiency, quality, and the patient experience. As a provider and medical professional, the South Country Health Alliance provider portal will give you the ability to check patient's eligibility, coverage, check claim status, view authorizations and referrals, and more. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service. MINNESOTA UNIFORM CREDENTIALING APPLICATION Initial Application – 09/2001; Revised 04/2002; Revised 06/2005; 01/2007; 08/2011, Revised 10/2016 Page 1 of 24 Minnesota Uniform Credentialing Application MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application DHS-3427-ENG (LTC SCREENING DOCUMENT *dhs-3427-eng* dhs-3427-eng 9-17 page 1 of 5 ltc screening document – ac, bi, cac, cadi, ecs, ew, mhm, msc+, msho, snbc document control number social security number DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER … *DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE Do you need help finding a dentist or scheduling a dental appointment? Delta Dental of Minnesota’s Customer Service can help! Call Customer Service toll-free at 1-800-774-9049 (TTY users call 711).. A Customer Service Representative can help you find a dental provider in your area, including a general dentist, oral surgeon, or orthodontist. SOUTH COUNTRY HEALTH ALLIANCE PROVIDER PORTAL Helping our provider network improve efficiency, quality, and the patient experience. As a provider and medical professional, the South Country Health Alliance provider portal will give you the ability to check patient's eligibility, coverage, check claim status, view authorizations and referrals, and more. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service. MINNESOTA UNIFORM CREDENTIALING APPLICATION Initial Application – 09/2001; Revised 04/2002; Revised 06/2005; 01/2007; 08/2011, Revised 10/2016 Page 1 of 24 Minnesota Uniform Credentialing Application MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application DHS-3427-ENG (LTC SCREENING DOCUMENT *dhs-3427-eng* dhs-3427-eng 9-17 page 1 of 5 ltc screening document – ac, bi, cac, cadi, ecs, ew, mhm, msc+, msho, snbc document control number social security number DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER … *DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Provider Assistance ; Provider Services: SCHA Provider Contact Center 1-888-633-4055: Health Services - Medical/Behavioral: SCHA Health Services Fax: 1-888-633-4052 PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. PHARMACY INFORMATION Pharmacy Help Desk Pharmacy Claims Online Drug Search; PerformRx. Medicaid 1-866-935-8874. Medicare 1-866-935-6681: 2021; Medicaid BIN # 019595; Medicaid PCN 6180000 SOUTH COUNTRY HEALTH ALLIANCE South Country is committed to identifying, preventing, correcting, and reporting fraud, waste, and abuse. The efforts undertaken as part of these processes are collaborative in nature and involve training and education, monitoring, audits including automated claims system checks, membership, and participation in the Minnesota Healthcare Fraud Taskforce, and more.PROVIDER FORMS
Can’t find a form on this page? Try the looking in the provider portal.The portal has several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE 1-866-567-7242 (toll-free) TTY 1-800-627-3529 or 711 SOUTH COUNTRY HEALTH ALLIANCE South Country Health Alliance members may be eligible for non-emergency medical transportation (NEMT) services to help them get to and from their health care appointments.PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. DHS-3427-ENG (LTC SCREENING DOCUMENT page 3 of 5 dhs-3427-eng 10-15. section d: screening/assessment results (alt 4) 75. assessment results and exit reasons. 75a. 75b. 76.effective date
MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE Do you need help finding a dentist or scheduling a dental appointment? Delta Dental of Minnesota’s Customer Service can help! Call Customer Service toll-free at 1-800-774-9049 (TTY users call 711).. A Customer Service Representative can help you find a dental provider in your area, including a general dentist, oral surgeon, or orthodontist. SOUTH COUNTRY HEALTH ALLIANCE PROVIDER PORTAL Helping our provider network improve efficiency, quality, and the patient experience. As a provider and medical professional, the South Country Health Alliance provider portal will give you the ability to check patient's eligibility, coverage, check claim status, view authorizations and referrals, and more. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service. MINNESOTA UNIFORM CREDENTIALING APPLICATION Initial Application – 09/2001; Revised 04/2002; Revised 06/2005; 01/2007; 08/2011, Revised 10/2016 Page 1 of 24 Minnesota Uniform Credentialing Application MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application DHS-3427-ENG (LTC SCREENING DOCUMENT *dhs-3427-eng* dhs-3427-eng 9-17 page 1 of 5 ltc screening document – ac, bi, cac, cadi, ecs, ew, mhm, msc+, msho, snbc document control number social security number DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER … *DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE Do you need help finding a dentist or scheduling a dental appointment? Delta Dental of Minnesota’s Customer Service can help! Call Customer Service toll-free at 1-800-774-9049 (TTY users call 711).. A Customer Service Representative can help you find a dental provider in your area, including a general dentist, oral surgeon, or orthodontist. SOUTH COUNTRY HEALTH ALLIANCE PROVIDER PORTAL Helping our provider network improve efficiency, quality, and the patient experience. As a provider and medical professional, the South Country Health Alliance provider portal will give you the ability to check patient's eligibility, coverage, check claim status, view authorizations and referrals, and more. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service. MINNESOTA UNIFORM CREDENTIALING APPLICATION Initial Application – 09/2001; Revised 04/2002; Revised 06/2005; 01/2007; 08/2011, Revised 10/2016 Page 1 of 24 Minnesota Uniform Credentialing Application MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application DHS-3427-ENG (LTC SCREENING DOCUMENT *dhs-3427-eng* dhs-3427-eng 9-17 page 1 of 5 ltc screening document – ac, bi, cac, cadi, ecs, ew, mhm, msc+, msho, snbc document control number social security number DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER … *DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Provider Assistance ; Provider Services: SCHA Provider Contact Center 1-888-633-4055: Health Services - Medical/Behavioral: SCHA Health Services Fax: 1-888-633-4052 PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. PHARMACY INFORMATION Pharmacy Help Desk Pharmacy Claims Online Drug Search; PerformRx. Medicaid 1-866-935-8874. Medicare 1-866-935-6681: 2021; Medicaid BIN # 019595; Medicaid PCN 6180000 SOUTH COUNTRY HEALTH ALLIANCE South Country is committed to identifying, preventing, correcting, and reporting fraud, waste, and abuse. The efforts undertaken as part of these processes are collaborative in nature and involve training and education, monitoring, audits including automated claims system checks, membership, and participation in the Minnesota Healthcare Fraud Taskforce, and more.PROVIDER FORMS
Can’t find a form on this page? Try the looking in the provider portal.The portal has several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE 1-866-567-7242 (toll-free) TTY 1-800-627-3529 or 711 SOUTH COUNTRY HEALTH ALLIANCE South Country Health Alliance members may be eligible for non-emergency medical transportation (NEMT) services to help them get to and from their health care appointments.PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. DHS-3427-ENG (LTC SCREENING DOCUMENT page 3 of 5 dhs-3427-eng 10-15. section d: screening/assessment results (alt 4) 75. assessment results and exit reasons. 75a. 75b. 76.effective date
MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Disclaimer: SeniorCare Complete and AbilityCare are health plans that contract with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service.PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER … *DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Disclaimer: SeniorCare Complete and AbilityCare are health plans that contract with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service.PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER … *DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE Do you need help finding a dentist or scheduling a dental appointment? Delta Dental of Minnesota’s Customer Service can help! Call Customer Service toll-free at 1-800-774-9049 (TTY users call 711).. A Customer Service Representative can help you find a dental provider in your area, including a general dentist, oral surgeon, or orthodontist. SOUTH COUNTRY HEALTH ALLIANCE Provider Assistance ; Provider Services: SCHA Provider Contact Center 1-888-633-4055: Health Services - Medical/Behavioral: SCHA Health Services Fax: 1-888-633-4052PROVIDER FORMS
Can’t find a form on this page? Try the looking in the provider portal.The portal has several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE Service Contact; Medical/Behavioral Health Services or Chiropractic: South Country Provider Contact Center 1-888-633-4055 Provider Manual Chapter 4, Provider Billing PHARMACY INFORMATION Pharmacy Help Desk Pharmacy Claims Online Drug Search; PerformRx. Medicaid 1-866-935-8874. Medicare 1-866-935-6681: 2021; Medicaid BIN # 019595; Medicaid PCN 6180000 SOUTH COUNTRY HEALTH ALLIANCE South Country Health Alliance members may be eligible for non-emergency medical transportation (NEMT) services to help them get to and from their health care appointments.PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. DHS-3936-ENG (MY MOVE PLAN SUMMARY) Title: DHS-3936-ENG (My Move Plan Summary) Author: State of Minnesota Subject: When a person who receives long-term services and supports is moving to a new residnece, he or she completes the My Move Plan Summary \(DHS-3936A\) form with support planner. MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Disclaimer: SeniorCare Complete and AbilityCare are health plans that contract with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service.PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER …DHS 5181 ENGDHS 3531 ENG 5 17DHS 6037 ENGDHS 2828 ENGDHS 3531 ENGDHS 3531 ENGFORM
*DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Disclaimer: SeniorCare Complete and AbilityCare are health plans that contract with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service.PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER …DHS 5181 ENGDHS 3531 ENG 5 17DHS 6037 ENGDHS 2828 ENGDHS 3531 ENGDHS 3531 ENGFORM
*DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE Do you need help finding a dentist or scheduling a dental appointment? Delta Dental of Minnesota’s Customer Service can help! Call Customer Service toll-free at 1-800-774-9049 (TTY users call 711).. A Customer Service Representative can help you find a dental provider in your area, including a general dentist, oral surgeon, or orthodontist. SOUTH COUNTRY HEALTH ALLIANCE Provider Assistance ; Provider Services: SCHA Provider Contact Center 1-888-633-4055: Health Services - Medical/Behavioral: SCHA Health Services Fax: 1-888-633-4052PROVIDER FORMS
Can’t find a form on this page? Try the looking in the provider portal.The portal has several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE Service Contact; Medical/Behavioral Health Services or Chiropractic: South Country Provider Contact Center 1-888-633-4055 Provider Manual Chapter 4, Provider Billing PHARMACY INFORMATION Pharmacy Help Desk Pharmacy Claims Online Drug Search; PerformRx. Medicaid 1-866-935-8874. Medicare 1-866-935-6681: 2021; Medicaid BIN # 019595; Medicaid PCN 6180000 SOUTH COUNTRY HEALTH ALLIANCE South Country Health Alliance members may be eligible for non-emergency medical transportation (NEMT) services to help them get to and from their health care appointments.PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. DHS-3936-ENG (MY MOVE PLAN SUMMARY) Title: DHS-3936-ENG (My Move Plan Summary) Author: State of Minnesota Subject: When a person who receives long-term services and supports is moving to a new residnece, he or she completes the My Move Plan Summary \(DHS-3936A\) form with support planner. MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Disclaimer: SeniorCare Complete and AbilityCare are health plans that contract with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service.PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER …DHS 5181 ENGDHS 3531 ENG 5 17DHS 6037 ENGDHS 2828 ENGDHS 3531 ENGDHS 3531 ENGFORM
*DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Disclaimer: SeniorCare Complete and AbilityCare are health plans that contract with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service.PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing Application DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER …DHS 5181 ENGDHS 3531 ENG 5 17DHS 6037 ENGDHS 2828 ENGDHS 3531 ENGDHS 3531 ENGFORM
*DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE Do you need help finding a dentist or scheduling a dental appointment? Delta Dental of Minnesota’s Customer Service can help! Call Customer Service toll-free at 1-800-774-9049 (TTY users call 711).. A Customer Service Representative can help you find a dental provider in your area, including a general dentist, oral surgeon, or orthodontist. SOUTH COUNTRY HEALTH ALLIANCE Provider Assistance ; Provider Services: SCHA Provider Contact Center 1-888-633-4055: Health Services - Medical/Behavioral: SCHA Health Services Fax: 1-888-633-4052PROVIDER FORMS
Can’t find a form on this page? Try the looking in the provider portal.The portal has several provider forms, including credentialing forms, authorization forms, and other provider network forms. SOUTH COUNTRY HEALTH ALLIANCE Service Contact; Medical/Behavioral Health Services or Chiropractic: South Country Provider Contact Center 1-888-633-4055 Provider Manual Chapter 4, Provider Billing PHARMACY INFORMATION Pharmacy Help Desk Pharmacy Claims Online Drug Search; PerformRx. Medicaid 1-866-935-8874. Medicare 1-866-935-6681: 2021; Medicaid BIN # 019595; Medicaid PCN 6180000 SOUTH COUNTRY HEALTH ALLIANCE South Country Health Alliance members may be eligible for non-emergency medical transportation (NEMT) services to help them get to and from their health care appointments.PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. DHS-3936-ENG (MY MOVE PLAN SUMMARY) Title: DHS-3936-ENG (My Move Plan Summary) Author: State of Minnesota Subject: When a person who receives long-term services and supports is moving to a new residnece, he or she completes the My Move Plan Summary \(DHS-3936A\) form with support planner. MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Disclaimer: SeniorCare Complete and AbilityCare are health plans that contract with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service. MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing ApplicationPROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER …DHS 5181 ENGDHS 3531 ENG 5 17DHS 6037 ENGDHS 2828 ENGDHS 3531 ENGDHS 3531 ENGFORM
*DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. MNSCHA.ORG - SOUTH COUNTRY HEALTH ALLIANCEPROGRAMSMEMBERSPROVIDERSCOUNTIESNEWSCREDENTIALING Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care SOUTH COUNTRY HEALTH ALLIANCE Use the South Country Provider Portal to review claims. If you do not find the information you are looking for or have additional questions please contact the Provider Contact Center at 1-888-633-4055. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September SOUTH COUNTRY HEALTH ALLIANCE Disclaimer: SeniorCare Complete and AbilityCare are health plans that contract with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. SOUTH COUNTRY HEALTH ALLIANCE Behavioral Health Forms. Can’t find a form on this page? Try the looking in the provider portal.The portal also contains several provider forms, including credentialing forms, authorization forms, and other provider network forms. PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. SOUTH COUNTRY HEALTH ALLIANCE What is an “appeal”? An “appeal” is when you ask South Country Health Alliance to review a decision we made to deny, terminate, or reduce a service or deny payment for a service. MINNESOTA UNIFORM CREDENTIALING APPLICATION Reappointment Application – 09/2001; Revised 04/2002; 04/2004, 01/2006, 07/2006, 01/2007, 08/2011, Revised 10/2016 Page 1 of 17. Minnesota Uniform Credentialing ApplicationPROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. DHS-5181-ENG (LEAD AGENCY ASSESSOR/CASE MANAGER/WORKER …DHS 5181 ENGDHS 3531 ENG 5 17DHS 6037 ENGDHS 2828 ENGDHS 3531 ENGDHS 3531 ENGFORM
*DHS-5181-ENG* DHS-5181-ENG 10-14 Page 1 of 4 Lead Agency Assessor/Case Manager/Worker LTC Communication Form Part 1: Sections A & B completed by the lead agency assessor. SOUTH COUNTRY HEALTH ALLIANCE Call 1-866-567-7242 (toll-free); Hearing Impaired/TTY: 1-800-627-3529or 711 Call center hours for Families & Children, MinnesotaCare, MSC+, SingleCare, and SharedCare members . 8 a.m.-8 p.m., Monday-Friday; Call center hours for AbilityCare (HMO SNP) and SeniorCareComplete (HMO SNP) members . 8 a.m.-8 p.m., Monday-Friday, from April through September PROVIDER AND PHARMACY DIRECTORY The provider directories show network health care facilities and practitioners available to you as a South Country Health Alliance member. The providers listed in the directories have agreed to provide you with your health care coverage. SOUTH COUNTRY HEALTH ALLIANCE Do you need help finding a dentist or scheduling a dental appointment? Delta Dental of Minnesota’s Customer Service can help! Call Customer Service toll-free at 1-800-774-9049 (TTY users call 711).. A Customer Service Representative can help you find a dental provider in your area, including a general dentist, oral surgeon, or orthodontist.PROVIDER FORMS
Can’t find a form on this page? Try the looking in the provider portal.The portal has several provider forms, including credentialing forms, authorization forms, and other provider network forms. PHARMACY INFORMATION Pharmacy Help Desk Pharmacy Claims Online Drug Search; PerformRx. Medicaid 1-866-935-8874. Medicare 1-866-935-6681: 2021; Medicaid BIN # 019595; Medicaid PCN 6180000 SOUTH COUNTRY HEALTH ALLIANCE Service Contact; Medical/Behavioral Health Services or Chiropractic: South Country Provider Contact Center 1-888-633-4055 Provider Manual Chapter 4, Provider Billing SOUTH COUNTRY HEALTH ALLIANCE Provider Assistance ; Provider Services: SCHA Provider Contact Center 1-888-633-4055: Health Services - Medical/Behavioral: SCHA Health Services Fax: 1-888-633-4052 SOUTH COUNTRY HEALTH ALLIANCE South Country Health Alliance members may be eligible for non-emergency medical transportation (NEMT) services to help them get to and from their health care appointments.PROVIDER MANUAL
The Provider Manual is a source of guidance and is not meant to be your only source for billing, authorization and coverage. DHS-3936-ENG (MY MOVE PLAN SUMMARY) Title: DHS-3936-ENG (My Move Plan Summary) Author: State of Minnesota Subject: When a person who receives long-term services and supports is moving to a new residnece, he or she completes the My Move Plan Summary \(DHS-3936A\) form with support planner. * Toggle High Contrast* Toggle Font size
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Welcome new members! See all that South Country Health Alliance has to offer. LEARN MORE South Country Health Alliance has a 4.5 out of 5-Star Health Plan SeniorCare Complete was named a 2021 Best Medicare Advantage Plan. Find out if SeniorCare Complete is right for you. Learn More Medicare Star Ratings Coronavirus/COVID-19 Information If you have care needs, please contact your local care provider to see what options are available to you. Some providers are offering telephonic visits andvideo visits.
Coronavirus and COVID-19 are all over the news. Get accurate information from the Centers for Disease Control and Prevention (CDC) and the Minnesota Departments of Health and Human Services. Click a link below to go to their websites. MNDept. of Health
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MN Dept. of Human Services South Country Health Alliance is committed to helping our members STAY SAFE in Minnesota by slowing the spread of COVID-19. We've gathered together links to official websites for the latest information on COVID-19; including questions on the vaccine, where to get it and when you are eligible to receive it. We have reason for optimism! We have started vaccinating those who are most at risk, COVID-19 cases are down, hospital capacity is steady, and our kids are heading back to the classroom. The sun is rising onthe pandemic.
For more info click on the highlighted COVID-19 Member link belowAudio __
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Use our drug search tool to search for your medication and see if it’s covered by South Country. SOUTH COUNTRY HEALTH ALLIANCE We are county-based health plan serving 9 counties in Minnesota, which was formed in 2001 to improve the way our members receive health care. We have more than 26,000 members and offer seven different programs to meet the needs of those in our counties. MEDICAL ASSISTANCE (MEDICAID) PROGRAMS * Medical Assistance (PMAP)* MinnesotaCare
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May 28 2021
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SOUTH COUNTRY INTRODUCES NEW LOGOChris Gartner
We are proud and excited to start the next new decade of South Country Health Alliance (South Country). Our company… Read MoreSep 30 2020
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DR. TIMOTHY MILLER JOINS SOUTH COUNTRY AS NEW MEDICAL DIRECTORChris Gartner
“We are excited to welcome Dr. Timothy Miller to our South Country team,” said South Country CEO Leota Lind. “He… Read MoreJun 30 2020
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SOUTH COUNTRY NAMED A 2020 TOP WORKPLACE BY STAR TRIBUNEChris Gartner
South Country Health Alliance has been named one of the Top Workplaces in Minnesota by the Star Tribune. Produced by… Read More SUBSCRIBE TO OUR PROVIDER E-NEWSLETTER Keep up with the latest South Country Health Alliance news andupdates.
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