Individual

The individual checklist is used to determine which items are needed for a clean application based on the provider's specialty type. The shaded areas indicate which items are required. Note: Mid-level includes nurse practitioners, physician assistants, certified registered nurse anesthetists, certified nurse midwives, clinical nurse specialists and hospital-based physicians. Ancillary includes speech, physical, occupational and audiology therapists.

Group Practice

The group practice checklist is used to determine which items are needed for a clean application based on the provider's group type. The shaded areas indicate what is required.

In-State, Out-of-Network

The in-state, out-of-network checklist is for providers that are in South Carolina, but want to remain out-of-network. It is used to determine which items are needed for a clean application based on their enrollment type. The shaded areas indicate what is required.

Note: This checklist only applies to individual practitioners. Group practices that wish to remain out-of-network must complete the Group Enrollment application and select No for the network participation question.

Behavioral Health

The behavioral health checklist is for providers who wish to join our behavioral health network. Behavioral health enrollment is managed by Companion Benefit Alternatives (CBA).

Electronic Signatures vs. Wet Signatures

These charts determine whether an application or form can be signed electronically.