For Molina Members About Molina
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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.

NEW Online Authorization Lookup

NEW Online Authorization Lookup

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.

ATTENTION: This Lookup tool is currently UNDER CONSTRUCTION.
click here to access our temporary searchable document.

Lookup CPT Code

Provider Services Portal

Check Member Eligibility & Benefits button

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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 S​ervices. 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.​

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:
  • 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

Distinction Status Award

Molina is excited to announce that the National Committee for Quality Assurance (NCQA) awarded Molina Healthcare of South Carolina the distinction status of 'Distinction in Multicultural Health Care'. ​​​​

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

ACR Information

Molina has incorporated American College of Radiology (ACR) guidelines into Molina's criteria of clinical decision support for advanced imaging. For more information contact Provider Services at (855) 237-6178 or email at click here.​

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. ​

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)

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