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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. 

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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.

Molina offers the following submission options:
  • Submit requests directly to Molina Healthcare of South Carolina via Availity 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
C/O Firstsource
1232 Premier Dr., Suite 100
Chattanooga, TN 37421

Provider and Member Rights and Responsibilities

As a contracted provider with Molina Healthcare, all participating providers are expected to adhere to a set of responsibilities. To review these provider responsibilities, please refer to the Molina Healthcare Provider Manual.
For your reference, we have also included Molina’s Member Rights and Responsibilities as a section in the Provider Manual. As a Molina provider, you and your staff agree to follow and comply with Molina’s administrative, medical management, quality assurance, and reimbursement policies and procedures.

No Copays

In accordance with SCDHHS requirements, Molina Healthcare will move to zero copays for all
Medicaid, MMP, and DSNP members, effective July 1, 2024.

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. 

Optum Pause and Pay Audits

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. 

Advanced Imaging Medical Guidelines

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 click here to email. 

Provider Changes

Please notify Molina at least 30 days in advance of any of the following changes: 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). Submit changes using the Provider Change Form and click here to email the updates to us.