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Welcome Molina Medicare Providers!

Important Update: As of July 1,2025, Molina Healthcare of Virginia no longer offers Medicare coverage. Medicare coverage with Molina ended
on June 30, 2025. For more details, contact Molina Provider Services.

It is important to Molina Healthcare and your patients that your provider directory demographics are accurate. Please visit our Provider Online Directory at: https://molina.sapphirethreesixtyfive.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)

Changes for 2026:

Medicare 2026 expansion includes:

  • Plan Expansions:
    • SNP: (4) new plan offerings in California, Illinois, Iowa, Massachusetts, Michigan, Ohio, South Carolina, and Texas
  • Service Area Expansions: New counties in (10) existing Molina states and (1) new state
    • Existing Molina States: California, Idaho, Illinois, Massachusetts, Michigan, Mississippi, New Mexico, Ohio, South Carolina, and Texas
    • New State: Iowa
  • Plan Non-Renewals: California Molina Medicare Complete Care HMO D-SNP), Michigan Molina Medicare Complete Care Select (HMO D-SNP), Texas Molina Medicare Complete Care HMO D-SNP), and Virginia Molina Medicare Complete Care HMO D-SNP) and Molina Medicare Complete Care Select (HMO D-SNP)

Provider Manuals

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Dental Provider Manual

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Forms

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EDI/ERA/EFT

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Prior Authorization Forms

Medical, BH, Pharmacy

2026 Medicare PA Form
2026 Medicare BH PA Form
2025 Medicare PA Guide
2025 Medicare PA Form
2025 Medicare BH PA Form
2025 Medicare Pharmacy PA Form
2025 Medicare Medical Pharmacy PA Form

2024 PA Code Matrices & Forms

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2023 PA Code Matrices & Forms
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Archive PA Code Matrices & Forms

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PA Criteria

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Guidelines

Preventive Health Guidelines
Clinical Practice Guidelines
Provider Portal User Guide
MCG Cite AutoAuth Provider Access Quick Resource Guide

Model of Care

Model of Care Provider Training Quick Reference Guide

2026 Model of Care Provider Training

 

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Health Resources

Behavioral Health Toolkit
Culturally and Linguistically Appropriate Resources
Medical Record Standards
Quality Improvement
Home Care FAQ

HEDIS/CAHPS

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Formulary

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Policies

Member Rights & Responsibilities
Provider Rights & Responsibilities
Advance Directives
Credentialing Rights
Fraud Prevention
Patient Safety
In Office Laboratory Tests

Payment Integrity Policies

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Services

Medication Therapy Management
Case Management
Disease Management 
Health Promotion
Nurse Advice
Smoking Cessation Resources

Care for Diverse Populations

Industry Collaborative Effort (ICE) – Better Communication, Better Care

    Communications

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    Rx Forms

    How to Request a Redetermination

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    Redetermination Form

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    Direct Member Reimbursement Form

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    Medicare Compliance Program

    The Molina Compliance Hotline:
    Ph: 866-606-3889

    To report an issue online visit: https://molinahealthcare.AlertLine.com

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    Medicare Compliance Training

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    Skilled Nursing Facility

    EMU Post Acute Clinical Request Form
    2017 Nursing Facility Provider

    Non-Contracted Providers

    Non-Contracted Provider Dispute and Appeals Processes
    Waiver of Liability