Coding and claim mechanics are national. What changes at a state line is everything around them: who adjudicates your Medicare claims and hears your appeals, what your Medicaid program is called and whether a commercial plan sits in front of it, whether an auto injury is the health plan's problem or the auto carrier's — and how a billing company is permitted to charge you.
In South Carolina, Medicare is administered by Palmetto GBA (JM). Medicaid runs as Healthy Connections, delivered largely through commercial managed care plans — so most Medicaid claims are adjudicated by an insurer with its own filing window and authorization rules rather than by the state.
South Carolina is a tort state for auto injuries, so standard coordination of benefits applies rather than a no-fault carrier taking first position.
White Glove Medical Billing is a medical billing, coding, and revenue cycle company — not a healthcare provider and not a law firm. All coding is performed by certified coders from your providers' documentation; the clinical record and the certification of medical necessity remain the provider's.
At a glance
Medicare contractor
Palmetto GBA (JM)
Medicaid program
Healthy Connections
Medicaid delivery
Commercial managed care plans
Auto injuries
Tort state — standard COB applies
Appeals in South Carolina
Palmetto GBA (JM) is who hears the first level of appeal for a Medicare denial here. That matters practically: an appeal argument that works with one contractor generally works across every state it covers, and local coverage determinations mean the same service can be covered in South Carolina and not one state over.
What we handle for South Carolina practices
- Medical coding by certified coders, from your documentation
- Charge entry, claim scrubbing, and electronic submission
- Clearinghouse rejection follow-up and denial management
- Payment posting reconciled to your bank deposits
- Aged A/R worked by recoverability, not by date
- Coordination of benefits sequenced across primary and secondary coverage
- Patient statements, payment plans, and a billing support line
A note on South Carolina business taxes
Not a service we sell, and not advice — but a practice is still a business with a state footprint, and it comes up often enough to be worth stating. South Carolina administers sales tax through the South Carolina Department of Revenue. Most clinical services are not taxable, but retail sales — supplements, cosmetics, optical, DME sold rather than billed — frequently are. Employer registration runs through the South Carolina Department of Employment and Workforce, and the entity itself is registered with the South Carolina Secretary of State. Your CPA owns all of it; we mention it because the retail side of a practice is where it usually surfaces.
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your South Carolina aging, denial mix, and payer panel.
Scope and price
A written scope, and the South Carolina rate card above confirmed in writing.
Transition
Coding and submission move across without a gap.
Report
Six numbers monthly, segmented by payer and provider.
Medical billing pricing in South Carolina
Percentage of collections
6–8% of what we collect for you
You pay a share of what actually lands in your account. If a claim is never paid, it costs you nothing — which is the point: it puts us on the same side of the denial as you are.
Every ongoing engagement carries a minimum monthly fee of $500. It exists so a new or small practice can be served properly rather than quoted a percentage that does not cover the work.
What changes the work in South Carolina
- Medicare contractor
- Palmetto GBA (JM)
- Claims for South Carolina providers are adjudicated here, and this is who hears the first level of appeal.
- Medicaid program
- Healthy Connections
- Delivered largely through commercial managed care plans, so most South Carolina Medicaid claims go to a health plan rather than to the state.
South Carolina shares its Medicare contractor with North Carolina, Virginia and West Virginia, so an appeal that works in one usually works in the others.
Front-end services in South Carolina
These are priced per occurrence and are the same in every state. They can be bought on their own, without a billing contract.
| Eligibility check | $5 per patient |
| Full benefits verification | $10–$14 per patient |
| Prior authorization, standard | $12 per authorization |
| Prior authorization, complex | $18–$25 per authorization |
| Patient registration audit | $4 per patient |
What we report every month
- Days in A/R — How long money takes to arrive.
- A/R over 90 days — What share of what you are owed is going stale.
- Clean claim rate — How often a claim is paid without rework.
- Net collection rate — Of what was collectable, how much we collected. The number that grades the whole engagement.
- Denial rate by reason — Grouped by cause, so it points at a fix rather than a total.
- Charge lag — Days from date of service to claim submission — often your number to fix rather than ours, which is exactly why you can see it.
South Carolina Guides
South Carolina Sales Tax Filing
Tracked, reconciled, and filed on the cadence South Carolina assigns you.
Open guideSouth Carolina Tax Agency Directory
Who administers what, with rates and thresholds as of August 2026.
Open guideAll Medical Billing Services
Monthly close, cleanup, AR/AP, payroll, job costing, and more.
Open guideSouth Carolina Medical Billing by Specialty
These specialties have medical billing that genuinely differs in South Carolina — workers compensation schedules, no-fault auto rules, or Medicaid structure.
South Carolina — Frequently Asked Questions
Which Medicare contractor covers South Carolina?
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Palmetto GBA (JM). That is who adjudicates your Medicare claims, publishes the local coverage determinations that bind you, and hears a redetermination.
Is South Carolina Medicaid managed care?
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Healthy Connections is delivered largely through commercial managed care plans. Nationally about 78% of Medicaid beneficiaries are in comprehensive managed care, and five companies account for roughly half of that enrollment — so "billing Medicaid" here usually means billing a commercial insurer.
How do you price in South Carolina?
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A percentage of collections, banded by practice size. The rate card above shows what applies.
Do we have to be in South Carolina to work with you?
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No — we work remotely with practices in all 50 states and DC. What matters is that somebody is tracking South Carolina's rules against your actual claims, which is what this page is for.
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