A goal to work for: A member success story

A 45-year-old Molina member needed help finding physical therapy and occupational therapy

but was hard to reach. Through persistence, our Care Managers not only reached her, but they

were able to guide her to the help that she needed. She was so encouraged talking to our

Care Managers that she was inspired to go back to school to work on getting her social worker’s

license. This member went from suffering strokes, having physical limitations, and depression, to

striving to work for Molina Healthcare after she graduates. We wish this member the best and we

hope one day that she can be on this side of Molina helping others.

PCP panel verification and panel status confirmation

As part of Molina Healthcare of South Carolina, ongoing efforts to improve the member experience and reduce unnecessary outreach to provider offices, we have enhanced our Primary Care Provider (PCP) change process to include a PCP Panel Verification step. Click here to read more.

2026 Medicaid Healthy Rewards Program is now LIVE!

Molina’s 2026 Annual Medicaid Healthy Rewards are here! These incentives reward members for completing recommended screenings by the end of the year. Check out the complete list of Healthy Rewards by clicking here. Medicaid members have been notified by mail of their recommended screenings and eligible rewards. 

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.

Why CAHPS survey results matter to providers

CAHPS survey results provide important insight into how members experience care and where providers can make the greatest impact. These results reflect more than patient perception—they highlight opportunities to strengthen access, communication, care coordination, and the overall care experience. Timely appointments, clear follow-up instructions, coordination across providers, and respectful, responsive interactions all influence how members evaluate their care. CAHPS results can help identify practical improvement opportunities that support stronger engagement, better continuity of care, and a more positive member experience. By understanding and acting on CAHPS results, both patient satisfaction and overall plan performance is impacted. The CAHPS Survey helps us all work together to make care better. Thank you for the care you give to our members every day.

Payer spaces reports tile is sunsetting

We’re excited to announce that the Reports Tile currently located in Payer Spaces will soon be replaced by the Reports (New) Tile. Click here for more information.

New digital process for inpatient continued stay requests

Molina is introducing a new digital option in the Availity Provider Portal. This allows providers to submit inpatient continued stay requests online. Click here for more information.

Appeals and disputes updates in the Availity Provider Portal

Molina is making it easier to submit appeals and disputes in the Availity Provider Portal.

These updates are designed to improve routing accuracy, reduce processing delays and ensure

requests are sent to the right team. Click here for more information.

New pediatric pharmacy support program now available

Molina has launched a new partnership with Perfecting Peds to support high‑risk, medically complex Medicaid members from birth through age 24. Perfecting Peds provides virtual pediatric clinical pharmacy support, working in collaboration with providers and families to assist with medication management, adherence, and care coordination for members with complex health needs.

Program services may include:

• Medication education for families
• Evidence‑based clinical recommendations
• Monitoring for side effects and drug interactions
• Support with complex treatment plans

Please click here for additional details. For questions, contact Molina Healthcare of South Carolina Provider Services at (855) 237‑6178, Monday–Friday, 8 a.m. to 5 p.m. local time.

You Matter to Molina

Our ‘You Matter to Molina’ program is built around supporting you. We understand that providing high-quality, efficient healthcare for Molina members starts with strong, collaborative relationships within our entire network of providers.

Our dedicated Provider Relations Team is here to serve as your direct connection to the health plan by listening, responding, and resolving your questions and concerns quickly. We actively seek your input on how we can strengthen our technology, tools, and processes to reduce administrative burdens and allow you to focus on caring for your patients. Your feedback is always valuable and prompts action. By collaborating, we can improve efficiency, enhance experience, and ultimately achieve better outcomes for our members. Click here for the full You Matter website.

Appeals process

Please be sure to check your remits and Availity for denial reasons. If a corrected claim is not needed, then file a formal appeal. Instructions can be found in the corresponding product manual. If you still do not agree with the outcome, you may escalate to your Provider Relations Representative for further research. Please note that a Reconsideration and Appeal are different on Availity. A reconsideration is an informal review. These have a turnaround time of 15 days. Formal appeals are still held to their turnaround time per the respective manual.

PA request

The preferred method of PA submission is through Availity. Availity offers a more streamlined provider experience compared to faxing. Contact Training@availity.com for training. Using an older version of the PA request form may cause delays in processing.

Authorization code look-up tool

Molina offers an electronic authorization code look-up tool for Medicaid. The authorization code look-up can be found here and on the provider web portal.

Claims denials

Claims denied for missing or additional documentation requirements such as consent forms, invoices, Explanation of Benefits from the primary carrier, or itemized bills are not considered claim disputes. To process your claim appropriately and promptly, these documents, along with a copy of the claim, must be received within federal and state timely filing requirements and/or your Provider Agreement with Molina. Please mail the documentation with a copy of the claim to the appropriate address per the Provider Manual. 

Medical director availability

Our Molina Medical Director can speak with a provider about any utilization management decision from 8 a.m. to 5 p.m., Monday through Friday, by calling our Provider Relations team at (855) 237-6178. First, select your requested line of business and follow the prompts for “Authorization” to reach the Utilization Management department.

Are you ADA compliant?

As a provider, you must inform Molina's South Carolina Network Administration by emailing us here if your facility is not ADA compliant or handicap accessible. Please outline the alternative accommodations being provided to members.

Continuity and coordination of provider communication

Molina stresses the importance of timely communication between providers involved in a member's care. This is especially critical between specialists, behavioral health providers, and the member's PCP. Information should be shared in such a manner as to facilitate communication of urgent needs or significant findings.

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.