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.
Easy to use online authorization lookup now available!
We’re making it easier than ever to look up which outpatient codes require authorization with our new online authorization lookup feature. Just type in your CPT code and our system will instantly let you know if authorization is required for this outpatient procedure. Remember, all inpatient series must be authorized so this new feature is not applicable for inpatient service codes.
Lookup CPT Code
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Molina’s Provider Self Services has a variety of tools to simplify your transactions whether you need to check eligibility or check claim status. For more information contact Provider Services. Molina Healthcare is now collecting National Provider IDs (NPIs) from contracted and non-contracted providers. Submit your NPI to Molina via our Provider Self-Services Portal.
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:
Prior Authorization (PA) Updates
Behavioral Tool Kit and HEDIS Tip Sheets
The Behavioral Tool Kit has been updated. You can find the HEDIS Tip Sheets in the Behavioral Tool Kit. To find this tool kit, please click on the Health Resources tab and then on Behavioral Tool Kit, or click here. To find the individual HEDIS Tip Sheets, please click below.
2018 HEDIS Behavioral Health Tip Sheets for Measurement Year 2017
Medicaid Provider Health Incentives Flyer
Claims Payment Update
Molina has moved to a weekly check run every Friday. Molina will still adhere to our Agreement of paying claims within 30 days.
Please notify Molina Healthcare at least 30 days in advance when you have any of the following:
“I love working with Molina, their claim department is responsive and efficient”
Dr. Marina Jones
We welcome the providers that have been serving South Carolina Solutions members for years. Joining the Molina Healthcare network is simple, quick and convenient.
As a physician-led organization, Molina is committed to providing quality health services in an efficient and caring manner to financially vulnerable families and individuals covered by government programs such as Medicaid and Medicare in the State of South Carolina.
Molina has a strong track record of providing superior customer service to providers. When you join our network, we make sure you get paid correctly and on time while getting the support you need. Please join us in South Carolina and see first-hand what the Molina difference can do for you.
For more information about Molina Healthcare, click here.
If you are interested in contracting with Molina Healthcare, email us at SCProviders@molinahealthcare.com.
For more information about the Medicaid program in South Carolina, visit the South Carolina Health and Human Services website.