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Provider updates & resources from Molina Healthcare of South Carolina
Winter 2023
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Provider Highlights and Important Information | |
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New Office Addresses
Molina Healthcare of South Carolina has new addresses for the following:
- Charleston physical office
115 Fairchild Street, Suite 340, Daniel Island, SC 29492. Molina also still has a physical office
location in Cayce, SC.
Attn: Molina Healthcare of South Carolina
C/O Firstsource
1232 Premier Dr., Suite 100
Chattanooga, TN 37421
- Utilization Management/Pharmacy appeals
Attn: Molina Healthcare of South Carolina
C/O Firstsource
PO Box 182273
Chattanooga, TN 37422
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Member How To Videos
SCDHHS released three instructional videos to help Healthy Connections Medicaid members complete their annual eligibility reviews. Healthy Connections Medicaid members can complete their annual eligibility review (click here), check their annual review status (click here), update their contact information, and submit required documents online (click here). The videos walk Medicaid members through the steps to create an online account and complete each function.
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Credentialing Update
Please note we will no longer be able to begin credentialing without a Medicaid ID. We will no longer take the reference number. The provider must have their full Medicaid ID before we proceed with credentialing.
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MHSC 2023 Healthy Incentives
Molina Healthcare Medicaid patients still have time to earn rewards for completing preventive screenings. Check out the complete list of Member Healthy Incentives by clicking here.
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2023 Medicare & Marketplace CAHPS Results Are In!
Molina conducted a Consumer Assessment of Health Care Providers and Systems (CAHPS) survey of a random sample of Marketplace, MMP/Duals and Medicare members asking how they rate their doctor, their overall health, and their health plan. The survey results determine where to focus improvement efforts. Click here to read the full article.
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New MHSC Partnerships Launching in 2024
Molina is excited to announce two new partnerships that will launch in 2024 to help close member care gaps and improve member experience.
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Ouma Health: MHSC is partnering with the maternal telehealth company, Ouma, to offer Medicaid members convenient patient-centric telehealth solutions designed to alleviate access barriers and to provide virtual clinical support until care is established. To learn more about Ouma click here.
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Decision Point: MHSC is partnering with the company, Decision Point, to help improve MHSC’s member satisfaction scores (Consumer Assessment of Healthcare Providers and Systems - CAHPS) and overall member experience using predictive analytics, machine learning, and actionable data insights. To learn more about Decision Point click here.
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ECHO Remits
Sign up for ProviderPayments.com so you can see your remits. If you have trouble understanding your EOP and locating advances, reach out to your provider rep at
[email protected] for our user guide.
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Model of Care
Medicare Model of Care Provider training for all Medicare PCP’s and high-volume specialists is due before 12/31/2023. The training and attestation can be found on our Medicare site here in the middle of the page, or you may request for your Provider Services rep to send it to you.
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Lab Redirection
Our preferred lab is Quest Diagnostics. We have identified some providers who are referring members to out-of-network labs. We will be doing outreach to understand why and help providers see the importance of referring to Quest and other in-network labs.
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Provider Manual Summary of Recent Changes
Updates have been made to our 2023 Provider Manuals for Medicaid, Marketplace, Medicare and MMP. Click here to find these changes outlined. You may view these changes at MolinaHealthcare.com.
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Medical Director Availability
Our Molina Medical Director can 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.
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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.
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General Billing Requirements Reminder
Prior authorized codes/services that are manually priced on the Medicaid Fee Schedule will be reimbursed at 35% of billed charges for covered benefits.
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Molina Help Finder
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. | |
Access To Care Standards
Molina is committed to providing timely access to care for all members in a safe and healthy environment. Molina will ensure providers offer hours of operation no less than offered to commercial members. Access standards have been developed to ensure that all health care services are provided in a timely manner.
The PCP or designee must be available 24 hours a day, seven days a week, to members for emergency services. This access may be by telephone. Appointment and waiting time standards are shown below. Any member assigned to a PCP is considered his or her patient. Molina may also assist with scheduling preventative health care appointments for our members. All specialty referrals should be coordinated by the primary care provider. To view the latest appointment standards, refer to the Quality section in Molina's Medicaid Provider Manual.
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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:
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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.
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The Molina Communications team produced this e-newsletter, which is designed for South Carolina health care providers. We welcome your feedback, news and ideas for content.
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PO Box 40309
North Charleston, SC 29423-0309
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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. © [current year] 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 [email protected].
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