Website update: MolinaHealthcare.com

MolinaHealthcare.com has been redesigned to make provider resources easier to find with improved navigation and search. Your Availity Essentials login is not changing, and existing links will automatically redirect after launch. Look for the new website launch expected in early October.

Important Update on Molina Healthcare of South Carolina 2027 Marketplace Plans

We want to inform you that Molina will not be offering Marketplace plans through the

Exchange in the State of South Carolina for the 2027 plan year. This decision was made

after careful consideration and strategic planning. Importantly, this change does not affect our full commitment to our other lines of business. We will continue to proudly serve our Molina Medicaid members and Molina Medicare Complete Care Plus (HMO D-SNP) members with the same dedication and excellence you’ve come to expect. Additionally, we remain fully committed to supporting our Marketplace members through the end of 2026, ensuring they continue to receive uninterrupted, quality care during this transition period.

Join us for a Molina Provider Town Hall!

Molina invites you to join us for an upcoming Provider Town Hall. Connect with the Molina team, hear important updates, and get answers to your questions.

In-Person – Greenville 📅 September 30, 2026 | 10 a.m. to 11 a.m.

Email SCProvider.Services@MolinaHealthcare.com to register and receive location details.

Virtual Town Hall 📅 October 1, 2026 | 10 a.m. to 11 a.m.

Join us virtually using the meeting link below. We look forward to connecting with you!

MHSC Q3 Town Hall - Virtual Option. Click here to register.

Molina's first Providers & Quality (P's & Q's) Chat

Women’s health discussion topics include: value based contract refresher, getting credit for the work you do, provider resources and member programs and rewards.

Tuesday, October 6, 10 a.m. - 11 a.m.

Thursday, October 8, 2 p.m. - 3:00 p.m.

RSVP: SCProvider.Services@MolinaHealthcare.com  

Credentialing and contracting contact update

Molina is streamlining how providers contact us for credentialing and contracting inquiries. By the end of 2026, the following mailboxes will be sunset:

MSC-Credentialing@MolinaHealthcare.com

SCProviderContract@MolinaHealthcare.com

Providers are encouraged to begin using our centralized Provider Services mailbox now for all credentialing and contracting inquiries:

SCProvider.Services@MolinaHealthcare.com

Please update your records to help ensure a smooth transition.

Change in authorization limits for psychotherapy services for Medicaid

We would like to inform you of an important change regarding the authorization

limits for Psychotherapy codes; (90832) PSYCHOTHERAPY W/PATIENT 30 MINS,

(90834) PSYCHOTHERAPY W/PATIENT 45 MINS and (90837) PSYCHOTHERAPY

W/PATIENT 60 MIN for all Medicaid Molina Healthcare members in South Carolina.

Effective October 1, 2026, prior authorization (PA) will be required AFTER (12)

cumulative visits of psychotherapy have been rendered in any combination of the

psychotherapy codes (90832+90834+90837). The (12) psychotherapy visits will

reset to zero each year (7/1 through 6/30).

Previously, PA was required AFTER (24) cumulative visits of psychotherapy were

rendered in any combination of the psychotherapy codes (90832+90834+90837).

The (24) psychotherapy visits reset to zero each year (7/1 through 6/30). If you have any questions or need further clarification, please email SCProvider.Services@MolinaHealthcare.com.

New provider portal launching October 26, 2026

Effective October 26, 2026, all Molina provider enrollment and credentialing requests must be submitted through the new Provider Network Management Portal. Providers can submit participation requests, add practitioners, and track application status online. The new portal is separate from Availity, which will continue to be used for claims, prior authorizations, and other existing functions. ProviderTrak training sessions will be available on October 15, 19, and 21.

Home health NOA compliance reminder

Effective November 1, 2026, Molina will process home health claims in accordance with CMS Notice of Admission (NOA) requirements. A one-time NOA must be submitted within five calendar days of the start of care and be on file before claims are billed. Claims without a valid or timely NOA may be subject to denial, reduction, or adjustment. Providers are encouraged to review their billing processes to ensure compliance and avoid payment disruptions.

New weekly ABA unit structure

Effective August 1, 2026, Molina transitioned ABA service authorizations and reimbursement to a weekly approved unit structure, replacing total authorized units for the full authorization period. Providers should bill for services delivered within each week, up to the weekly approved unit limit, and review authorizations to ensure billing systems reflect the new structure. Claims exceeding approved weekly units may be denied or adjusted. Existing authorizations and previously submitted claims are not impacted. Medical necessity requirements, prior authorization requirements, and covered ABA CPT® codes remain unchanged.

Balance billing reminder

Members may not be balance billed for covered services beyond any applicable copayment, coinsurance, or deductible. Providers are responsible for verifying member eligibility and obtaining prior authorization when required. Providers should not bill members for amounts that are Molina’s responsibility, including:

• Medicare Part A or Part B cost-sharing for members who are dually eligible for Medicare and Medicaid.
• The difference between Molina’s negotiated rate and the provider’s usual and customary charges.
• Additional fees for covered services beyond the member’s applicable copayment, deductible, or coinsurance.

Please ensure billing practices comply with Molina requirements and that members are protected from inappropriate financial liability.

Claims submission update

Molina recently implemented enhanced front-end claims validation edits to support compliance with South Carolina Medicaid requirements and improve claims processing accuracy. These edits validate key claim elements such as provider NPIs, taxonomy codes, ordering/referring provider requirements, admission information, and other required claim data. As a result, some providers may see an increase in claim rejections if required information is missing, invalid, or does not align with state enrollment records. Providers are encouraged to review claim submissions carefully and ensure all required provider and claim data are included to help avoid processing delays.

Continued stay requests now available in Availity

Molina is pleased to announce that the Continued Stay enhancement is now available in the Availity Provider Portal. This enhancement allows providers to submit inpatient continued stay requests electronically, helping reduce fax submissions and streamline the review process.

Providers can now:

• Select an existing inpatient authorization
• Use the Update button to extend the service end date
• Attach required clinical documentation
• Submit the continued stay request directly through Availity

We encourage providers to take advantage of this new functionality for a faster, more streamlined submission process.

Vision claims billing reminder

To help ensure vision claims are processed correctly, please keep the following in mind:

• Providers who are not enrolled with VSP may be considered out-of-network for Molina vision services.
• When billing Molina for medical eye care services, both routine and medical diagnosis codes may be reported on the claim when appropriate.
• The diagnosis pointer associated with the billed service line is critical. If a service line points to a routine vision diagnosis code, the claim will be redirected to VSP.
• For medical eye care services, ensure the procedure code is linked only to the appropriate medical diagnosis code through the diagnosis pointer field.

Reviewing diagnosis pointers prior to claim submission can help prevent processing delays, claim denials, and misrouting of services between routine vision and medical benefits.

Medicaid provider ID reminder

To help ensure timely and accurate claims payment, Molina reminds providers that all applicable Pay-To, Billing, Rendering, and Supervising providers must maintain active South Carolina Healthy Connections Medicaid enrollment and a valid South Carolina Medicaid Provider ID. Claims may deny or reject when a provider associated with the claim does not have an active Medicaid enrollment or valid Medicaid Provider ID on file.

If you have not yet completed enrollment with SCDHHS, please begin the process as soon as possible and notify Molina once your Medicaid Provider ID has been assigned so we can update our records. For questions, please contact Molina Provider Services at SCProvider.Services@MolinaHealthcare.com.

Nursing facility payment and coverage reminder

Molina is committed to supporting timely transitions of care and helping providers navigate Medicaid coverage requirements. For South Carolina Healthy Connections Medicaid members, SCDHHS reimburses Medicaid-covered Skilled Nursing Facility (SNF) and Long-Term Care (LTC) nursing facility services directly through Medicaid Fee-for-Service (FFS). These nursing facility services are not reimbursed by the member’s Medicaid Managed Care Organization (MCO). Because these services are reimbursed directly by SCDHHS, prior authorization from Molina is not required for nursing facility admissions. Providers should continue to follow all applicable SCDHHS requirements, including Medicaid eligibility, level-of-care determinations, and facility admission processes.

Medicare Model of Care training

Molina reminds participating providers that annual Model of Care (MOC) training is required for providers who care for Molina Medicare members enrolled in Special Needs Plans (SNPs). The Model of Care helps ensure members receive coordinated, comprehensive, and member-centered care.

Training covers key elements such as care coordination, interdisciplinary care teams, health risk assessments, individualized care plans, and communication across the member’s care team. Providers and appropriate staff should complete the required Molina Medicare Model of Care training annually and maintain documentation of completion as required. Thank you for partnering with Molina to support high-quality, coordinated care for our Medicare members.

Every visit counts: Improving the CAHPS® member experience

The CAHPS® survey measures member experiences with access, communication, care coordination, service, and overall satisfaction. These results inform healthcare quality and CMS Star Ratings. 2026 CAHPS results are here. Clear communication, respectful care, timely follow-up, coordination, and access drive a positive member experience.

Members value providers who listen, explain care clearly, show respect, and coordinate timely follow-up. Key opportunities include specialist access, simpler referrals, and clearer support.

How providers can help

• Communicate clearly: Listen, use plain language, and confirm understanding.
• Follow through: Share results, referrals, and next steps promptly.
• Coordinate care: Exchange information across care teams.
• Improve access: Help members navigate appointments and referrals.
• Show respect: Make every interaction welcoming and patient centered.

Clear communication, timely access, and coordinated care strengthen member trust, health outcomes, and CAHPS® performance.

Quality Updates

Per NCQA, when certain immunizations are administered after specific timeframes, the member will not be considered compliant for the Childhood Immunization Status (CIS-E) and Immunizations for Adolescents (IMA-E) HEDIS measures. Take advantage of the Boo to the Flu and HPVIP campaigns to help get your members in and compliant. To learn more, please email SCProvider.Services@MolinaHealthcare.com.

As a reminder:

• Molina offers up to $200 for Medicaid-enrolled newborns who complete six well visits with recommended immunizations ($150) AND both Influenza doses ($50) by age two.
• Molina offers up to $50 for Medicaid-enrolled adolescents who complete both HPV doses before age 13.

Members can claim Molina Healthy Rewards by logging into their Molina Member Portal at MyMolina.com.

Medical record upload available to close gaps in care

Molina now offers the ability to upload medical documentation to close Gaps in Care. Providers may also submit exclusion details for members who are not eligible for inclusion in measure criteria.

For more information or support, please contact SC Provider Services at SCProviderServices@MolinaHealthcare.com.

Important ORP provider reminder

South Carolina Healthy Connections Medicaid requires providers who order, refer, or prescribe (ORP) services for Medicaid members to be enrolled with SCDHHS, even if they do not directly bill Medicaid. Effective July 1, 2026, claims for ordered or referred services are required to include the NPI of the ordering or referring provider. Claims that do not include the federally required ORP information may be rejected and payment may not be issued. Providers are encouraged to verify that ordering and referring practitioners are appropriately enrolled with SCDHHS and that the correct NPI is included on applicable claims.

Connect members to resources with Molina Help Finder

Molina Help Finder makes it easy for providers to connect members with low- and no-cost community resources that can support their health and well-being. Providers can search for local assistance with food, housing, transportation, childcare, employment, education, health services and more, helping address social needs that may impact a member’s health. Visit Molina Help Finder to explore resources available in your community.

Looking for a Molina provider policy?

Molina makes it easy for providers to access important policies, guidelines, and resources online. Providers are encouraged to regularly review Molina’s website for the most current information that may impact billing, authorization, clinical requirements, and other provider operations. Visit the Molina Healthcare of South Carolina Provider website and navigate to the appropriate policies section to view available resources. Keeping up with Molina policies helps support accurate claims processing and a smooth experience for you and our members.

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.

Got Value-Based Contracts?

Now is the time to sign up for calendar year 2027 Value-Based Contracts with Molina.

• Per the CMS guidelines (eCFR: 42 CFR 438.3), any reimbursement outside of fee-for-service must be tied to specific, measurable, and documented clinical or quality improvement standards, also referred to as a Value-Based Contract (VBC). 

Don’t let this additional reimbursement for your practice pass you by!

To learn more, please reach out to SCProviderContract@MolinaHealthcare.com.

Join our email list

Sign up for Molina's provider email list here. Be the first to receive our provider newsletters, news, and updates about Molina services, delivered automatically to your inbox. We will not spam your inbox but just send important information and updates.

For other questions or inquiries regarding this newsletter, please email us at:

PalmettoPartners@MolinaHealthcare.com

Verify your fax number

Molina sends out other important communications to providers by fax. We'd like to ensure we have your most up-to-date fax numbers and information.

Please email us at PalmettoPartners@MolinaHealthcare.com to verify or update your information.

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

All summaries of the measures contained herein are reproduced with permission from HEDIS Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA).

The information presented herein is for informational and illustrative purposes only. It is not intended, nor is it to be used, to define a standard of care or otherwise substitute for informed medical evaluation, diagnosis and treatment which can be performed by a qualified medical professional. Molina Healthcare, Inc. does not warrant or represent that the information contained herein is accurate or free from defects.

COPYRIGHT NOTICE AND DISCLAIMER

The HEDIS® measures and specifications were developed by and are owned by NCQA. The HEDIS measures and specifications are not clinical guidelines and do not establish a standard of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures and specifications. NCQA holds a copyright in these materials and can rescind or alter these materials at any time. These materials may not be modified by anyone other than NCQA. Use of the Rules for Allowable Adjustments of HEDIS to make permitted adjustments of the materials does not constitute a modification. Any commercial use and/or internal or external reproduction, distribution and publication must be approved by NCQA and are subject to a license at the discretion of NCQA. Any use of the materials to identify records or calculate measure results, for example, requires a custom license and may necessitate certification pursuant to NCQA’s Measure Certification Program. Reprinted with permission by NCQA. © 2026 NCQA, all rights reserved.

Limited proprietary coding is contained in the measure specifications for convenience. NCQA disclaims all liability for use or accuracy of any third-party code values contained in the specifications.

The American Medical Association holds a copyright to the CPT® codes contained in the measure specifications. 



The American Hospital Association holds a copyright to the Uniform Billing Codes (“UB”) contained in the measure specifications. The UB Codes in the HEDIS specifications are included with the permission of the AHA. The UB Codes contained in the HEDIS specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting HEDIS measure results or using HEDIS measure results for their internal quality improvement purposes. All other uses of the UB Codes require a license from the AHA. Anyone desiring to use the UB Codes in a commercial product to generate HEDIS results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@aha.org.