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.
Need a Prior Authorization?
Please refer to the state specific Excel matrix while the PA Lookup Tool is disabled.
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://molina.sapphirethreesixtyfive.com//?ci=sc-medicaid&locale=en_us
- 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:
- Click here to find out more about Optum prepay.
- Click here to get more information on in-office laboratory tests.
- 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 SCProviderServices@MolinaHealthcare.com
- 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)
Provider and Member Rights and Responsibilities
Prior Authorization Updates
New Fax for Physician Administered Medication Requests
Effective 8/1/21, Molina will require all Medicaid and Marketplace physician-administered prior authorization medication requests to be faxed to our Pharmacy team at the following number: (855) 571-3011. For more information, click here.
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.
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.