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://www.availity.com/molinahealthcare
- 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
Molina will be implementing place of service changes for provider administered drugs. Please click
here for more details about this change.
Our HEDIS Tip Sheets have moved to the provider portal. Click
here to log into the portal to access the latest copies.
As of 1/1/2020, Molina has moved to a 30-day readmission policy.
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)
As a Primary Care Provider by designation, you can always access the roster of Molina Marketplace members assigned to your practice via your provider portal. However, you do not need to be designated as a member’s PCP to provide services to Molina members. Eligibility and benefit terms apply.
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