Providers

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Communications & Important Reminders

As our health care partner, it’s important that you have all the latest information about Molina’s operations. Please click the Provider Communication links below for up-to-the-minute details about Molina’s key plan updates, legislative changes, industry trends and news, upcoming meetings, training opportunities, and emergent issues in the industry.

Provider Newsletters Communications & Important Reminders Resources & Training Covid-19

Announcements and Reminders

Important Reminder:

It is important to Molina Healthcare and your patients that your provider directory demographics are accurate. Please visit our Provider Online Directory at: providersearch.molinahealthcare.com 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)

Appeals

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.

MSCAN Pre-Service Appeals Form

CHIP 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. 

MSCAN Post-Service Appeals Form

CHIP Post-Service Appeals Form

Primary Care Designation Reminder

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.

PsychHub

PsychHub is an online plaform for digital mental health education. Molina Providers are able to access PsychHub online learning courses through their Learning Hub for FREE. Contact your local Molina provider services team.

Read More PsychHub

Marketplace Service Areas

View the states, counties, and communities we serve

Benefits of Provider Portal

Take care of business on your schedule. Available 24/7, the Provider Portal gives you an easy way to make short work of a number of tasks, including:

• Check Member Eligibility

• Submit and check the status of your claims

• Submit and check the status of your service or request authorizations

• View your HEDIS scores

• Prior Auth Lookup Tool

Click to Login or Register Benefits of Provider Portal

Stay up to date with our Molina Resources

Health Resources

Quality Improvement | HEDIS | CAHPS | Culturally and Linguistically Appropriate Resources | Clinical Practice Guidelines | Preventive Health Guidelines | Health Management | Integrated Case Management | Molina’s 24 Hour Nurse Advice Line | Opioid Safety Resources | Utilization Management | HEDIS/CAHPS Tip Sheets | Provider Education Series

EDI ERA/EFT

EDI | ERA/EFT

HIPPA

HIPAA Transactions | HIPAA Code Sets | Unique Identifiers | Privacy of Health Info | HIPAA Security | Contact HIPAA

Drug List

Drug Formulary | Medication Prior Authorization Criteria and Clinical Policies | Physician Administered Preferred Drug List

Policies

Member Rights and Responsibilities | Fraud Prevention Tips | Reimbursement Policies

Need Help?

View our FAQs for answers to some commonly
asked questions.

View FAQs