The end of the federal public health emergency (PHE) gives way to the resumption of Medicaid redetermination. The redetermination process can be a complex and potentially stressful experience for our members, and Molina is committed to offering compassionate assistance to ensure they receive the care they need. Please click here for important information regarding Redetermination and the full article.

Effective August 1, Molina will partner with ProgenyHealth, a company specializing in Neonatal Care Management Services, which will improve services to our members and promote healthy outcomes for premature and medically complex newborns. Your process for notifying Molina of infants admitted to a NICU or special care nursery will change on 8/1/2023. Please notify ProgenyHealth directly of admissions via fax at (888) 250-8468, and their clinical staff will contact your designated staff to perform utilization management and discharge planning throughout the inpatient stay. To learn more about ProgenyHealth’s programs and services, call (888) 832-2006 or visit progenyhealth.com.

The South Carolina Department of Health and Human Services (SCDHHS) has released warnings about active Medicaid renewal scams targeting Healthy Connections Medicaid members. Click here for the full report from SCDHHS. 

Provider Manual Summary of Recent Changes

Updates have been made to our 2023 Provider Manuals for Medicaid, Marketplace, and MMP. Click here to find these changes outlined. You may view these changes at MolinaHealthcare.com.  

MUSC Hollings Cancer Center has taken an innovative approach to improving South Carolina’s HPV vaccination rates through launching a community mobile vaccination van. This mobile unit travels to underserved communities and schools throughout the state to administer the HPV vaccine series, as well as several other child and adolescent immunizations.

For more information, please visit the program website: MUSC HPV Vaccination Van. If you have any questions about the program or upcoming events, please contact Melanie Slan at [email protected] or 843-876-2427.

As you know, Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey is a valuable tool in measuring patient satisfaction and improving the quality of care.

The CAHPS Survey measures the patient’s experience with the healthcare organization, access to care, communication with healthcare providers, coordination of care and overall satisfaction of care. Survey results provide valuable insights into how well health plans are meeting the needs of their members.

The CAHPS Survey measures the effectiveness of the provider and patient interaction. This measurement has a significant impact on their overall patient satisfaction. Patients often rate their health plan based on their interaction with their providers. Taking the time to listen to patients, communicate effectively, and provide compassionate care are all key factors to the overall patient experience and satisfaction.

The CAHPS Survey results are publicly reported, and health plan ratings are based on those results. High ratings can improve a health plan’s reputation and attract new members while low results have the opposite effect.

CAHPS Survey results are essential for health plans because the results provide valuable insight into patient satisfaction, identify areas for improvement, and help make data-driven decisions that enhance the quality of care.

Check out these extra benefits we offer in addition to what is covered by the Healthy Connections program. These are all available at no extra cost to our members!

To learn more about extra free benefits, go to Medicaid Value Adds | Molina Healthcare of South Carolina.

Osteoporosis is a disease that affects approximately 10 million Americans, while another 44 million suffer from low bone density, placing them at a higher risk of bone fractures. Unfortunately, many people do not realize that focusing on bone health during childhood is crucial as it sets the foundation for strong and healthy bones in adulthood. Therefore, it is important to adopt healthy habits early on to help prevent future bone-related health issues. In the United States, two million fractures occur every year due to osteoporosis, which often results from neglecting bone health. For members who require pharmacologic interventions, please click here for Molina’s preferred medications.

The maximum clinical information fax size threshold Molina Healthcare can accept is no more than 100 pages (10 MB) for the total size of the fax transmission. Anything over the 100 page (10 MB) threshold will fail.

Molina requires copies of current and relevant clinical information to be submitted for documentation to ensure accurate and timely clinical decision-making. Clinical information includes but is not limited to pertinent physician emergency department notes, inpatient history/physical exams, discharge summaries, physician progress notes, physician office notes, physician orders, nursing notes, results of laboratory or imaging studies, therapy evaluations,

and therapist notes. Click here for the full article.

An Expedited/Urgent service request, including appeal requests, should only be used if the treatment is required to prevent serious deterioration in the member’s health or could jeopardize the member’s ability to regain maximum function. Requests outside of this definition should be submitted as routine/non-urgent requests (pursuant to Medicare 42 CFR § 422). If the request meets the criteria for Expedited/Urgent, please indicate the reason at the time of the submission to avoid delays and follow all CMS guidelines. As a reminder, request services in a timely manner and provide necessary information for review so appropriate and timely decisions can be made. 

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

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.

Do you know any members who need help finding basic needs such as housing, food, clothing and job training? Molina Help Finder can help members get connected with the resources they need to help them. Send them to MolinaHelpFinder.com for more information.

Molina offers an electronic authorization code look-up tool for both our Medicaid and MMP lines of businesses. The authorization code lookup can be found here for Medicaid, here for MMP, and on the provider web portal. It can also be found on our main provider main page here.

Let us help you close gaps in care! Request your gaps in care report to identify who needs a well visit, immunizations, screenings, and tests. Call the Provider Engagement team manager for your latest report or email [email protected].

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:

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 [email protected] to verify or update your information.

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. © [current year] NCQA, all rights reserved.

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 [email protected].