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Provider Bill of Rights
Provider Bill of Rights 1.1 Provider is assured of the following rights:    a. A healthcare professional, acting within the lawful scope of practice, ...
/providers/sc/medicaid/policies/memrights.aspx
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Quality Improvement
The Molina Healthcare Quality Improvement (QI) Program provides the structure and key processes that enable the health plan to carry out its commitment to ongoing improvement of care and service, and ...
/providers/sc/medicaid/resource/qualimp.aspx
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HIPAA 5010 Readiness
aMolina Healthcare’s HIPAA 5010 Readiness *Molina Healthcare is ready to test the 5010 versions of the HIPAA transactions with providers and other trading partners.  We look forward to working collabo...
/providers/sc/medicaid/Copy-of-hipaa/5010Readiness.aspx
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HIPAA Code Sets
The Federal HIPAA regulations issued by DHHS dictate that only approved code sets may be used in standard electronic transactions. The CMS site has official resources that define these standard code s...
/providers/sc/medicaid/Copy-of-hipaa/codesets.aspx
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Unique Identifiers
Molina Healthcare has implemented the HIPAA NPI requirements. Beginning May 23, 2008, HIPAA standard transactions must include NPIs.  No legacy identifiers (other than the billing/pay-to provider's Ta...
/providers/sc/medicaid/Copy-of-hipaa/npi.aspx
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HIPAA Transactions
HIPAA Standards for Electronic Healthcare TransactionsHIPAA required the Department of Health and Human Services (HHS) to adopt national standards for electronic healthcare transactions. All covered e...
/providers/sc/medicaid/Copy-of-hipaa/tcs.aspx
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HIPAA Transaction Readiness
Since HIPAA’s inception, Molina Healthcare has worked diligently and collaboratively with the broader healthcare community to achieve compliance with the federal HIPAA transactions requirements. Molin...
/providers/sc/medicaid/Copy-of-hipaa/tcs_readiness.aspx
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Frequently Used Forms
Please click on a form below to view a PDF printable version. The files below are in PDF format () February 2020 Marketplace EDC Analyzer Sample Fax Home Health-PGDM FAQs Claims Reconsideratio...
/providers/sc/marketplace/forms/fuf.aspx
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Fraud Prevention Tips
Molina Healthcare of South Carolina ("Molina") seeks to uphold the highest ethical standards for the provision of health care benefits and services to its members, and supports the efforts of federa...
/providers/sc/marketplace/policies/fraud.aspx
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EDI
​​Molina supports our Providers, and as such would like to highlight the many benefits of electronic claims submission that will have direct impact on your time! EDI will help: Efficient informatio...
/providers/sc/medicaid/ediera/edi/benefits.aspx