Providers

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Communications & Important Reminders

As our health care partner, it’s important that you have all the latest information about Molina’s operations. Please click the Provider Communication links below for up-to-the-minute details about Molina’s key plan updates, legislative changes, industry trends and news, upcoming meetings, training opportunities, and emergent issues in the industry.

Provider Newsletter Communications & Important Reminders Covid-19

Announcements and reminders

Provider Dispute and Appeals Submissions

Molina has gone green, and is requesting that all providers submit provider dispute and appeals electronically. Electronic submission provides benefits to providers including faster disputes and appeals processing, increased overall efficiencies, improved processing accuracy and reduced HIPAA violations.

Any disagreement regarding the processing, payment or non-payment of a claim is considered a provider dispute. Provider disputes are typically disputes related to overpayment, underpayments, untimely filing, missing documents (i.e. consent forms, primary carrier explanation of benefits) and bundling issues. Provider Appeals are requests related to a denial of an authorization or medical criteria. A provider has 90 days from date of remittance denial to dispute a claim.

Molina offers the following submission options:

  • Submit requests directly to Molina Healthcare of South Carolina via the Provider Portal at: https://provider.molinahealthcare.com
  • Submit requests directly to Molina Healthcare of South Carolina via fax at (877) 901-8182
  • Submit Provider Disputes through the Contact Center at (855) 882-3901
  • Submit requests via mail to:
Molina Healthcare of South Carolina
Provider Dispute and Appeals
PO Box 40309
North Charleston, SC 29423-0309

Site of Care Infusion Information

Molina will be implementing place of service changes for provider administered drugs. Please click here for more details about this change.​

HEDIS Tip Sheets

Our HEDIS Tip Sheets have moved to the provider portal. Click here to log into the portal to access the latest copies.

Important Update

As of 1/1/2020, Molina has moved to a 30-day readmission policy.​

Important Reminder

Please notify Molina Healthcare at least 30 days in advance when you have any of the following:
  • Change in office location, office 
       hours, phone, fax, or email
  • Addition or closure of office location
  • ​Addition or termination of a provider
  • Change in Tax ID and/or NPI
  • Open or close your practice to new
       patients (PCPs only)

PsychHub

PsychHub is an online plaform for digital mental health education. Molina Providers are able to access PsychHub online learning courses through their Learning Hub for FREE. Contact your local Molina provider services team.

Read More PsychHub

Marketplace Service Areas

View the states, counties, and communities we serve

Benefits of Provider Portal

Take care of business on your schedule. Available 24/7, the Provider Portal gives you an easy way to make short work of a number of tasks, including:

• Check Member Eligibility

• Submit and check the status of your claims

• Submit and check the status of your service or request authorizations

• View your HEDIS scores

• Prior Auth Lookup Tool

Click to Login or Register Benefits of Provider Portal

Stay up to date with our Molina Resources

Health Resources

Quality Improvement | HEDIS | CAHPS | Culturally and Linguistically Appropriate Resources | Clinical Practice Guidelines | Preventive health guidelines | Health management | Integrated case management | Molina’s 24 Hour Nurse Advice line | Opioid Safety Resources | Utilization Management | HEDIS/CAHPS Tip sheets | Provider Education Series

EDI ERA/EFT

EDI | ERA/EFT

HIPPA

HIPAA transactions | HIPAA code sets | Unique Identifiers | Privacy of health Info | HIPAA Security | Contact HIPAA

Drug List

Drug Formulary | Medication Prior Authorization Criteria and Clinical Policies | Physician Administered Preferred drug list

Policies

Member Rights and Responsibilities | Fraud Prevention Tips | Reimbursement Policies

Need Help?

View our FAQs for answers to some commonly
asked questions.

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