Frequently Asked Questions

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EDI

Can I submit COB claims electronically?

Yes, Molina and our connected Clearinghouses fully support electronic COB.

Do I need to submit a certain volume of claims to send EDI?

No, any number of claims via EDI saves both time and money.

Which Clearinghouses are currently available to submit EDI claims to Molina?

What claims transactions are currently accepted for EDI transmission?

837P (Professional claims), 837I (Institutional claims).

Where can I find more information on the HIPAA transactions?

How do I exchange the 270/271 Eligibility Inquiry?

Molina does not directly exchange the Eligibility transactions. The transactions may be sent to Molina's contracted clearinghouse Change Healthcare to verify Eligibility.

How do I exchange the 276/277 Claim Status Inquiry/Response?

Molina does not directly exchange the Claim Status transactions. The transactions may be sent to Molina's contracted clearinghouse Change Healthcare to verify Claim Status.

What do I do if I still have questions?

ERA-EFT

Does Molina offer Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT)?

  • Yes. Molina Healthcare offers ERA/EFT with our contracted vendor solution ProviderNet. Please refer to EDI Enrollment Forms ERA/EFT for more information.

Do I get charged for being configured for EFT through ProviderNet?

  • No.This is a FREE service for you to take advantage of Molina Healthcare picks up any fees related to the accessibility of your payment data as well as the EFT payment.

Why does registration for EFT/ERA require that I have received a paper check payment from Molina Healthcare?

The reason behind this necessity is to ensure that the person registering the Provider has the authority to do so, and is aware of the Explanation of Payment (EOP) name and address information – while registering with ProviderNet.

  • An initial payment to at least one Tax ID + NPI association is necessary to become eligible for EFT thru ProviderNet.
  • If the Provider has multiple NPIs associated to one Tax ID, then only one affiliation needs a paper check number.
  • If the Provider has multiple Tax IDs and NPIs, then each Tax ID would need a minimum of one paper check from Molina.

I called ProviderNet, and they say I'm registered, but I'm still receiving paper checks?

Ensure you have completed the following verification steps:
  • You must have signed and returned an ACH Authorization form as well as a voided check or bank verification letter for the account you designated to receive your deposits to ProviderNet.It takes 24-48 hours for ProviderNet to process these documents once received.
    • You can verify whether ProviderNet received/processed your documents by clicking on “Accounts” on your Control Panel in the ProviderNet portal. You will see your account information at the bottom of the page.
    • If the status says “Pending” you will need to wait until your account has been verified, and the status changes to “Verified.”
    • If “ACH?” or “Check” show “NO” then Provider Net has not received/processed your ACH Authorization Form and voided check/bank verification letter. If it has been more than 48 hours since the documents were sent, please re-send the documents. Documents may be faxed to 972-348-5524 or emailed to: wco.provider.registration@changehealthcare.com
    • If status shows “Verified” and “ACH?” and “Check?” show “Yes” move on to next step.
  • Please verify that the bank account and routing information provided to ProviderNet is valid (this could possibly cause delays in finalizing of your set-up).
  • The addresses in ProviderNet need to EXACTLY match the addresses Molina Healthcare has on file.
    • You can verify your ProviderNet addresses by clicking on “Addresses” in the ProviderNet Portal Control Panel.
    • Click on “Address History” (toward the top of the page), and select each address/facility for which you would like to receive EFT payments, then click the “Save” button.

Note:

If you are a Provider that has multiple entities with similar names, you may want to make sure that you have registered for each entity.NPIs that are receiving payments from Molina Healthcare, you will need to register each NPI. Please see the instructions for adding additional NPIs.

How long does it take for pre-note approval?

  • Up to , 10 calendar days.

Can I make a change to my bank account information on ProviderNet?

  • Yes, but if you change an account that is already verified and is associated to an address, the EFT process will be interrupted.
  • The best thing to do is add another account on the “Accounts” page, once it has been verified (up to a ten calendar day process) you may then delete the old account and associate the new account with all applicable locations.

Can I set up multiple users on my ProviderNet account?

  • Yes. The User Administration feature can be used to add and maintain users and their permissions. You may also change your login information at My Profile.

How do I view my EOPs that are associated with the EFT payment now that I am no longer receiving the paper check?

  • The EOPs are available to view and download on the ProviderNet website.If you are currently receiving EFT payments your facility has been registered in ProviderNet and there are login credentials to the ProviderNet website for the NPI associated to the EFT payment.

How long does it normally take for the EFT payment to get applied to my bank account (after I am a registered provider)?

  • For verified bank accounts, the money is transferred within 24 hours of Molina's payment process. Your bank may vary on when they release the funds into your account. Usually it is the next business morning; however please check with your bank on specifics.

How long does my EOP remain available on ProviderNet for view/download/save?

  • The EOP PDF will remain online for up to 24 months after original payment.

If I have a Clearing house that manages my payables, can I have my (ERA) EDI/835 files go directly to them?

  • If your Clearing house is already activated with ProviderNet, you set up connectivity with them to receive your EDI 835 files.
    • To do this, click on “Connectivity” on your ProviderNet Control Panel, then select the “Clearinghouses” tab.
    • Select your clearinghouse from the drop-down list. Select the (ERA) EDI 835 file as the “File Type,” enter a start date, and hit “Save”.
    • You should see your clearinghouse listed at the bottom of the page. Note: Expect for Molina Healthcare of Puerto Rico Providers, (ERA) EDI 835 files are only distributed with EFT payments.
  • If you are already receiving EFTs, your clearing house will receive your EDI 835 files based on the start date you choose. (You can back-date if desired.)
  • If your Clearing house is not activated with ProviderNet, please contact them to get set-up. It is free to the Clearing house, and to the Provider