Thank you for investing your time in Palmetto Partners, Molina's e-newsletter for providers.

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Molina's Provider Portal has a variety of tools to simplify your transactions, whether you need to check eligibility, check claim status, or submit disputes. For more information, contact Provider Services at (855) 237-6178.

You can find our Provider Manuals here for each line of business:

Medicaid, MMP

Marketplace, Medicare

Here’s where Molina is covered for each LOB: Medicaid – every county, MMP – every county, Medicare – every county except Oconee, Marketplace – every county except Oconee, Pickens, and Anderson.

When you submit a corrected claim, the original claim number must be present in field 64 for a UB, and field 22 for a 1500. The claim will be rejected if this is not filled out correctly.

Molina currently has a 30 day readmission policy.

Molina is performing additional pre-payment claim reviews. For more information on Optum Pre-pay, please click here.

Providers are required to inform Molina's South Carolina Network Administration by emailing us here if they are not ADA compliant or handicap accessible and provide what alternative accommodations are being offered to members.

In this newsletter, you'll find all kinds of great information and valuable resources. This newsletter will be an asset to you, from what's going on with Molina Healthcare of South Carolina to important provider communications.

You are an essential part of quality care for our members. We value our partnership and appreciate the family-like relationship 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 your efforts to provide quality care. Thank you for your continued partnership.

2023 is off to a busy start. This quarter Molina will be preparing for both the Annual External Review Audit, conducted by the Carolinas Center for Medical Excellence (CCME) on behalf of South Carolina Department of Health and Human Services (SCDHHS), as well as NCQA auditors, who will be reviewing our plan at the end of March.

The big headline is the end of the Public Health Emergency (PHE) and the resumption of eligibility determinations for Medicaid recipients. Since the suspension during PHE, the number of Medicaid recipients in Managed Care and FFS has grown to approximately 1.5 million individuals. It’s expected that approximately 300k will likely lose eligibility throughout the next year. Many of these current members may, for example, have aged out during the pandemic or obtained employment and now access other insurance. SCDHHS reaffirmed their commitment to limit the annual reviews to 1/9 monthly as much as possible but recognized that this limit might be exceeded in the early months when categorically ineligible members are the targeted populations.

Please take every opportunity to inform and remind your Medicaid patients that re-determination starts in April. Also important is that SCDHHS has a current address and phone number on file to ensure successful outreach. SCDHHS allows address changes to be made online.

If a patient loses eligibility, another alternative for health care coverage is the Health Exchange, also known as Marketplace or Obama care. These plans are often low or no premium options to cover your patient. Patients can shop online or use a broker or navigator to help best choose a plan that fits their needs.

Thank you so much for participating with Molina. We are proud to have you in our network serving our members. Molina depends on our providers to deliver quality care, and we’re here to help you be successful.

Molina partnered with Our Lady’s Pantry at Catholic Charities, Prisma Health, SCDHHS, and SCDHEC to start a formula bank in Greenville. This infant formula bank, located at Our Lady’s Pantry, was made to address the gap in infant formula access for families awaiting WIC enrollment. Molina made the first financial donation of $10,000 which helped get this project moving forward.

“In the spring of 2022, a small group of people affiliated with public and private organizations met to discuss families’ lack of access to baby formula due to system and supply issues. It was immediately obvious this systems challenge would require many community partners’ ideas, resources, and talents. The financial contribution from Molina and the contributions of many community partners led to the creation of a formula bank serving families in the Greenville area. SCDHHS is thankful for the collaborative effort that produced a solution to this challenge and will continue to help improve health outcomes for our youngest Healthy Connections Medicaid members and their families,” said Kristine Hobbs, Director of Community Initiatives for Healthy Connections Medicaid.