Welcome, South Carolina Healthcare Providers
Contracted providers are an essential part of delivering quality care to our members. We value our partnership and appreciate the family-like relationship that you pass on to our members. As our partner, assisting you is one of our highest priorities. We welcome your feedback and look forward to supporting all of your efforts to provide quality care.
If you have any questions, please call Provider Services at (855) 237-6178.
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:
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.
As of 1/1/2020, Molina has moved to a 30-day readmission policy.
Webinars and Training Sessions
Be on the lookout for upcoming webinars, orientations and educational sessions.
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)