Molinalogo

• Step One - Connect

  Points of contact and the process for joining our network will differ depending on the type of provider that you are. Please follow the instructions below for your provider type:

   

  Dental Providers

  Please contact the appropriate dental vendor based on line of business.   Medicaid: SKYGEN Dental, networkdevelopment@skygenusa.com FIDE D-SNP: SKYGEN Dental, networkdevelopment@skygenusa.com Marketplace: Delta Dental, pr@deltadentalil.com or (630) 718-4990   Note: If you are an oral surgeon or facility, you must apply for participation with both Molina Healthcare of Illinois and the dental vendor. Please complete a Contract Request Form and submit to MHILProviderNetworkManagement@molinahealthcare.com to begin the process (outlined in Steps Two through Four below) and also contact the vendor directly.

  Vision Providers

  Please contact the appropriate vision vendor based on line of business.   Medicaid: Avēsis Vision, (866) 857-8124 FIDE D-SNP: VSP Vision, (800) 742-6907 Marketplace: VSP Vision, (800) 742-6907

  Hearing Providers

  FIDE D-SNP: NationsHearing, (800) 921-4559

  Pharmacy Providers

  Please contact our Pharmacy benefits partner, CVS Pharmacy, by visiting CVS website here: Join CVS Caremark Network.

  All Other Providers

  Please complete a Contract Request Form and submit to MHILProviderNetworkManagement@MolinaHealthcare.com.

   

   

• Step Two - Documentation

  If your Contract Request Form is accepted, our Provider Network Management team will provide you with contracting documents that must be completed. Documents you receive may differ depending on provider type, and may include:

  • - Provider Agreement
  • - Provider Information Form
  • - Ownership and Control Disclosure Form
  • - W-9
  • - Practitioner Application (if practitioner does not have an updated and attested CAQH profile)

  • - IAMHP Universal Roster

  
  

  Find these documents on our Frequently Used Forms page. Upon receipt of completed documents, Provider Network Management will then begin the network enrollment process.

• Step Three - Credentialing

  Providers must meet credentialing requirement via the Illinois IMPACT system. Get the process started at Provider Enrollment (illinois.gov).

   

• Step Four - Contract

  The final step will be for Molina to countersign your Provider Agreement and provide you with a signed copy. Credentialed facilities and/or practitioners will also be loaded into Molina’s claims payment system as in-network providers. The in-network effective date for each facility and/or practitioner will be the date of credentialing completion, which will be included in the notification that you will receive from Molina (referenced above in Step Three – Credential).

Already a participating provider but would like to join an existing participating group? Please complete a Provider Information Update Form and submit along with an updated roster to MHILProviderNetworkManagement@molinahealthcare.com.

Adding a Provider to a Participating Group? Please complete a Provider Information Update Form and submit along with an updated roster to MHILProviderNetworkManagement@molinahealthcare.com.