Providers

It is important to Molina Healthcare and your patients that your provider directory demographics are accurate. Please visit our Provider Online Directory to validate your information and notify us if there are any updates.

Please notify Molina Healthcare at least 30 days in advance when you have any of the following:

• Change in office location,
     office hours, phone, fax, or email
• Addition or closure of office location
• Addition or termination of a
     provider
• Change in Tax ID and/or NPI
• Open or close your practice to new
     patients (PCPs only)

Pre-Service Appeals

For providers seeking to appeal to denied Prior Authorization (PA) on behalf of a member only, fax Member Appeals at (844) 808-2407.

Marketplace Pre-Service Appeals Form

 

Post-Service Appeals

For providers seeking to appeal a denied claim only, fax Provider Claim Disputes/Appeals at (844) 808-2409.

If a provider rendered services without getting an approved PA first, providers must submit the claim and wait for a decision on the claim first before submitting a dispute/appeal to Molina. 

Marketplace Post-Service Appeals Form

 

 

As a Primary Care Provider by designation, you can always access the roster of Molina Marketplace members assigned to your practice via your provider portal. However, you do not need to be designated as a member’s PCP to provide services to Molina members. Eligibility and benefit terms apply.