Need a Prior Authorization?
Welcome, South Carolina Healthcare Providers
Our contracted providers are vital to delivering quality care to our members. We value our partnership and prioritize assisting you.
The Availity Essentials Provider Portal can help you verify eligibility, submit claims, check claim status, submit attachments, and more. Provider Relations representatives are available to help you provide information about our business partnerships, quality initiatives, and more. Click here to find your Provider Relations representative or contact our Provider Services at (855) 237-6178.
Find out more about how Molina can be a resource to providers by clicking on the video below.
Provider Dispute and Appeals Submissions
Claims Dispute and Appeal Steps:
1. Check your remits for denial reasons
2. Submit a corrected claim when applicable
3. Inform Molina promptly when you disagree with a payment or lack of payment (call or use Availity)
4. File a formal appeal when appropriate
5. If you still do not agree with the outcome, you may escalate to your provider relations representative for further research
To file a formal appeal please complete the Medicaid Appeals Request Form and attach it with the applicable relevant documentation.
- Submit requests directly to Molina Healthcare of South Carolina via Availity at: 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:
Provider and Member Rights and Responsibilities
Provider Updates
Molina has partnered with Optum to implement best practices to reduce waste, abuse, and error in medical claim billing through a pre-payment review. Click here to view the Optum Pause and Pay Payment Policy or click here to view the most frequently asked questions related to pre-payment review. Please click here for the updated information on the Optum-Change Healthcare outage.
Quick Links
Prior Authorization Request Form
Behavioral Health Prior Authorization Form
Prior Authorization Pre-Service Review Guide
Moral and Religious Objections to Specific Services
As per our South Carolina Department of Health and Human Services Medicaid Contract, we are required to identify providers who decline to offer certain services due to moral or religious objections, including family planning services. If you have any objections, please complete this form and return it via email at SCProvider.Services@MolinaHealthcare.com.
Town Hall Meetings
Molina will be hosting virtual Town Halls. We want to keep open and ongoing communication with you, and one of the best ways for us to do this is through our town halls.
Wednesday, Aug. 13, 10am & 2pm
Wednesday, Oct. 22, 10am & 2pm
Where to register: Click on the session you will be attending above to register.
What we need: Practice name and the following for all attendees: name, phone, title and email address
Site of Care Drug List
On 1/1/2021, Molina started requiring certain provider-administered medications (HCPCS J Codes) to be administered in the home or at independent fusion centers – not in a hospital setting (exceptions may apply). Click here for the complete list and more information that includes the medications and classes that will be impacted by this change.