Effective date: June 23, 2026
This organization, providing Non-Emergency Medical Transportation (NEMT) and/or ambulance transportation services, complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and applicable South Carolina Medicaid regulations administered by the South Carolina Department of Health and Human Services (SCDHHS), including coordination requirements established through the state’s contracted NEMT broker, ModivCare.
We recognize that our operations require the collection, use, and transmission of Protected Health Information (PHI), including but not limited to:
- Member identification and Medicaid eligibility information
- Trip scheduling, manifests, pickup, and drop-off data
- Mileage, level-of-service, and vehicle assignment documentation
- Physician Certification Statements (PCS) and medical necessity documentation
- Billing records, claims submissions, and broker remittance data (ModivCare)
Safeguards & Compliance Controls
We maintain internal safeguards designed to support HIPAA compliance and South Carolina Medicaid program integrity, including:
- Role-based access controls limiting PHI access to authorized personnel only
- Secure scheduling, dispatch, documentation, and billing systems
- Encryption and secure transmission of PHI where applicable
- Workforce training on HIPAA, fraud, waste, and abuse prevention, and Medicaid billing requirements
- Standardized documentation practices supporting accuracy and audit traceability
- Internal review processes to reduce billing errors, duplicates, and incomplete claims
- Retention procedures supporting Medicaid and ModivCare audit requirements
South Carolina Medicaid & ModivCare Audit Readiness
We maintain documentation practices designed to support South Carolina Medicaid and ModivCare broker requirements, including:
- Verification of required trip documentation (including PCS where applicable) prior to claim submission
- Retention and accessibility of supporting medical necessity documentation
- Trip-level billing records traceable to operational source documentation
- Compliance with ModivCare broker submission, correction, and billing workflows
- Cooperation with SCDHHS, ModivCare, and authorized auditors in audits, reviews, and corrective action processes
Permitted Use of Information
PHI is used and disclosed only as permitted under HIPAA, including for treatment, payment, and healthcare operations (TPO), or as otherwise authorized by the member or required by law, SCDHHS requirements, or ModivCare broker procedures.
Commitment to Compliance
We are committed to maintaining ongoing compliance with HIPAA and South Carolina Medicaid requirements, including ModivCare broker standards, and continuously improving internal controls, documentation accuracy, and operational processes to support program integrity and reliable transportation services.
For questions regarding privacy practices or compliance policies, please contact our Compliance Department.